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Lin SY, Huang HY, Chiang LT, Huang LY, Wang CC. Use of calcium channel blockers and risk of breast cancer among women aged 55 years and older: a nationwide population-based cohort study. Hypertens Res 2023; 46:2272-2279. [PMID: 37253976 DOI: 10.1038/s41440-023-01321-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/31/2023] [Accepted: 05/03/2023] [Indexed: 06/01/2023]
Abstract
This retrospective cohort study was aimed to compare the incidence of breast cancer among women aged ≥55 who received calcium channel blockers and angiotensin converting enzyme inhibitors/angiotensin II receptor blockers. We used the 2002-2015 Health and Welfare Database in Taiwan. Women 55 years and older who initiated antihypertensive treatment were included. Breast cancer risk for patients receiving calcium channel blockers was compared to those receiving angiotensin converting enzyme inhibitors/angiotensin II receptor blockers. Cox proportional hazards models were used to generate adjusted hazard ratios for breast cancer. We found that the risk of breast cancer was similar between calcium channel blockers users and angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (adjusted hazard ratio [aHR] and 95% CI = 1.03 [0.80 to 1.34]). No significant risk increase was observed in the stratified analysis by dihydropyridine (aHR = 1.02 [0.78 to 1.33]) and non-dihydropyridine calcium channel blockers (aHR = 1.23 [0.48 to 3.20]). No difference in the risk of breast cancer associated with calcium channel blockers exposure was observed in patients who used hormone replacement therapy (aHR = 1.02 [0.29 to 3.58]). The risk for breast cancer was observed to be significantly lower in patients receiving calcium channel blockers than in those receiving angiotensin converting enzyme inhibitors/angiotensin II receptor blockers at a treatment duration of 5 or more years (aHR = 0.57 [0.33 to 0.98]). In conclusion, the risk for breast cancer is similar for calcium channel blockers and angiotensin converting enzyme inhibitors/angiotensin II receptor blocker users in an Asian population.
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Affiliation(s)
- Shin-Yi Lin
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsin-Yi Huang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Liang-Ting Chiang
- Cardiovascular Center, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ling-Ya Huang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Chuan Wang
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Zhu XX, Li JH, Fang P, Qu XF, Liang LJ, Lai JM, Yin XY. Renin-angiotensin system inhibitors improve the survival of cholangiocarcinoma: a propensity score-matched cohort study. BMC Cancer 2023; 23:826. [PMID: 37670280 PMCID: PMC10478452 DOI: 10.1186/s12885-023-11152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/04/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Hypertension is a risk factor for cholangiocarcinoma (CCA). The effect of anti-hypertensive drugs on the prognosis of CCA is not clear. METHODS This is a retrospective study of 102 patients (56.9% males, median age 66 years) diagnosed with CCA and hypertension concurrently and received radical surgery (R0), with a median follow-up of 36.7 months. Kaplan-Meier analysis, Cox regressions, and propensity score (PS) matching were applied for statistical analysis. RESULTS Results of multivariable cox analysis showed that renin-angiotensin system inhibitors (RASis) usage was a protective factor for progression-free survival (PFS) (hazard ratio [HR] = 0.55, 95% confidence interval [95% CI]: 0.32-0.96) and overall survival (OS) (HR = 0.40, 95% CI: 0.20-0.79), respectively. Calcium channel blockers, diuretics, and β-blockers didn't show significant associations. The association of RASis usage and PFS and OS was derived by PS matching, with a cohort of 28 RASis users and 56 RASis non-users. The median PFS and OS of RASis users (PFS, 17.6 months (9.2-34.4); OS, 24.8 months (16.5-42.3)) were longer than RASis non-users (PFS, 10.5 months (4.1-24.1); OS, 14.6 months (10.6-28.4)). The 1 year, 2 years, and 3 years' survival rates of RASis users (89.1%, 77.0%, and 65.5%) were higher than RASis non-users (70.9%, 54.0%, and 40.0%). CONCLUSIONS RASis usage improves the survival of patients with CCA and hypertension concurrently.
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Affiliation(s)
- Xiao-Xu Zhu
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong, 510080, China
| | - Jian-Hui Li
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong, 510080, China
| | - Peng Fang
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong, 510080, China
| | - Xiao-Fei Qu
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong, 510080, China
| | - Li-Jian Liang
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong, 510080, China
| | - Jia-Ming Lai
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong, 510080, China.
| | - Xiao-Yu Yin
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong, 510080, China.
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Douillard M, Deheb Z, Bozon A, Raison-Peyron N, Dereure O, Moulis L, Soria A, Du-Thanh A. Over diagnosis of bradykinin angioedema in patients treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. World Allergy Organ J 2023; 16:100809. [PMID: 37638360 PMCID: PMC10458346 DOI: 10.1016/j.waojou.2023.100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/24/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
Background Bradykinin angioedemas are a potentially serious side effect of angiotensin-converting enzyme inhibitors (ACEI) and more controversially of angiotensin II receptor blockers (ARB). Their challenging diagnosis is based on the absence of any recurrence after more than 6 months of drug discontinuation; otherwise mast-cell driven angioedemas as a differential diagnosis must be considered. Objective The aim of this study was to determine the prevalence of recurrent angioedema in patients referred for ACEI/ARB-induced bradykinin angioedema, after more than 6 months of drug discontinuation. Methods We included ACEI/ARB-treated patients referred for angioedema(s) without hives and unresponsive to antihistamines, after they discontinued ACEI/ARB for at least 6 months. Any C1-inhibitor deficiency was excluded. The primary endpoint was the prevalence of patients with recurrent angioedema after more than 6 months of drug discontinuation and/or developing hives during follow-up. The secondary endpoint was the identification of epidemiological factors associated with any final diagnosis. Results Thirty-eight of 93 patients (41%) with a suspicion of ACEI/ARB-induced bradykinin angioedema still had recurrent angioedema (n = 27) or developed hives (n = 2) or both (n = 9) after 6 months of drug discontinuation. Good response to icatibant and facial but not oral localization were predictive for the final diagnosis of ACEI/ARB-induced bradykinin angioedema and mast-cell driven angioedema, respectively. Conclusion In patients referred for acquired angioedema without wheals occurring during ACEI/ARB therapy, 59% finally had a diagnosis of ACEI/ARB-induced bradykinin angioedema whereas 41% were rather diagnosed with mast-cell driven angioedema. The overdiagnosis of ACEI/ARB-induced bradykinin angioedema may deteriorate the management of severe cardiovascular conditions.
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Affiliation(s)
- Marie Douillard
- Department of Dermatology, St Eloi Hospital, 34000, Montpellier, France
| | - Zineb Deheb
- Médecine Sorbonne Université, Service de Dermatologie et Allergologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Agathe Bozon
- Department of Dermatology, St Eloi Hospital, 34000, Montpellier, France
| | | | - Olivier Dereure
- Department of Dermatology, St Eloi Hospital, 34000, Montpellier, France
| | - Lionel Moulis
- Clinical and Epidemiological Research Unit, CHU, Montpellier, 34000, France
| | - Angèle Soria
- Médecine Sorbonne Université, Service de Dermatologie et Allergologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Cimi-Paris, INSERM 1135, Paris, France
| | - Aurélie Du-Thanh
- Department of Dermatology, St Eloi Hospital, 34000, Montpellier, France
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Georgianos PI, Vaios V, Divani M, Liakopoulos V. Should we discontinue RAS-inhibitor therapy in patients with advanced CKD? Expert Opin Pharmacother 2023; 24:977-980. [PMID: 37185138 DOI: 10.1080/14656566.2023.2207738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023]
Affiliation(s)
| | - Vasilios Vaios
- Department of Nephrology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Divani
- Hemodialysis Unit, General Hospital of Larissa, Larissa, Greece
| | - Vassilios Liakopoulos
- Department of Nephrology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Lee JM, Choi S, Jeong S, Son JS, Park SJ, Chang J, Park SM. Distinct effects of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on major depressive disorder: A nationwide cohort study. Asian J Psychiatr 2023; 81:103436. [PMID: 36630835 DOI: 10.1016/j.ajp.2022.103436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Jun Myong Lee
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea; Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seogsong Jeong
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea; Department of Biomedical Informatics, CHA University School of Medicine, Seongnam, South Korea
| | - Joung Sik Son
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Jooyoung Chang
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea; Department of Family Medicine, Seoul National University College of Medicine, Seoul, South Korea.
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Dow T, Selman T, Williams J, Bezuhly M. The Role of ACE-Inhibitors and ARBs in reducing hypertrophic scarring following bilateral breast reduction. J Plast Reconstr Aesthet Surg 2023; 78:1-3. [PMID: 36669236 DOI: 10.1016/j.bjps.2022.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/05/2022] [Revised: 08/20/2022] [Accepted: 11/17/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The angiotensin-renin system (ARS) has been shown to play a role in the promotion of tissue fibrosis through angiotensin II activation of the angiotensin-receptor 1 and subsequently transforming growth factor beta-1 (TGF- β1). Breast reduction surgery is known to have a potential complication of hypertrophic scarring. The primary objective of this study is to assess whether the use of angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blockers (ARBs) by patients undergoing bilateral reduction mammoplasty is correlated with a reduction in hypertrophic scarring complications post-operatively. METHODS A retrospective chart review of all patients who received bilateral breast reduction surgery in our province over a 10-year period was performed. Patient charts were reviewed for post-operative hypertrophic scarring as well as medications being used around the time of surgery. The rate of hypertrophic scarring within patients treated with an ACEi or ARB for existing hypertension were compared with the rest of the population. RESULTS A total of 981 patients met the inclusion criteria of the study. The overall incidence of hypertrophic scarring was 6%. Within the population, 132 (14%) of patients had a clinical diagnosis of hypertension. Of the patients who were managed with an ACEi or ARB, one (2%) patient developed hypertrophic scarring post-operatively. This was significantly less than the total population and the remainder of the population with hypertension treated with a medication other than an ACEi or ARB. CONCLUSIONS This study investigated the impact of routine ACEi or ARB use by patients undergoing bilateral reduction mammoplasty and demonstrated a statistically significant reduction in the incidence of hypertrophic scarring. This study is one of the first to investigate ACEi or ARB use in humans to reduce rates of unsightly scarring. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Todd Dow
- Division of Plastic Surgery and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Tamara Selman
- Division of Plastic Surgery and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason Williams
- Division of Plastic Surgery and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- Division of Plastic Surgery and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Moulder JE, Cohen EP, Medhora M, Fish BL. Angiotensin converting enzyme (ACE) inhibitors as radiation countermeasures for long-duration space flights. Life Sci Space Res (Amst) 2022; 35:60-68. [PMID: 36336371 DOI: 10.1016/j.lssr.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 06/16/2023]
Abstract
Angiotensin converting enzyme (ACE) inhibitors are effective countermeasures to chronic radiation injuries in rodent models, and there is evidence for similar effects in humans. In rodent models ACE inhibitors are effective mitigators of radiation injury to kidney, lung, central nervous system (CNS) and skin, even when started weeks after irradiation. In humans, the best data for their efficacy as radiation countermeasures comes from retrospective studies of injuries in radiotherapy patients. We propose that ACE inhibitors, at doses approved for human use for other indications, could be used to reduce the risk of chronic radiation injuries from deep-space exploration. Because of the potential interaction of ACE inhibitors and microgravity (due to effects of ACE inhibitors on fluid balance) use might be restricted to post-exposure when/if radiation exposures reached a danger level. A major unresolved issue for this approach is the sparse evidence for the efficacy of ACE inhibitors after low-dose-rate exposure and/or for high-LET radiations (as would occur on long-duration space flights). A second issue is that the lack of a clear mechanism of action of the ACE inhibitors as mitigators makes obtaining an appropriate label under the Food and Drug Administration Animal Rule difficult.
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Affiliation(s)
- John E Moulder
- Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 United States
| | - Eric P Cohen
- Nephrology, New York University School of Medicine, 550 First Ave, New York, NY 10016 United States.
| | - Meetha Medhora
- Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 United States
| | - Brian L Fish
- Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 United States
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Holloway-Kew KL, Betson AG, Anderson KB, Sepetavc F, Gaston J, Kotowicz MA, Liao WH, Henneberg M, Pasco JA. Fracture Risk and Use of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers. Calcif Tissue Int 2022; 111:396-408. [PMID: 35833952 PMCID: PMC9474347 DOI: 10.1007/s00223-022-01004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022]
Abstract
Medications used to treat hypertension may affect fracture risk. This study investigated fracture risk for users of angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB). Participants (899 men, median age 70.3 yr (59.9-79.1), range 50.0-96.6 yr; 574 women, median age 65.5 yr (58.1-75.4), range 50.1-94.6 yr) were from the Geelong Osteoporosis Study. Medication use was self-reported and incident fractures were ascertained using radiological reports. Bone mineral density (BMD) was measured at the femoral neck. Participants were divided into four groups: (1) non-users without hypertension, (2) non-users with hypertension, (3) ACEI users and (4) ARB users. Dosage was calculated using the defined daily dose (DDD) criteria. Participants were followed from date of visit to first fracture, death or 31 December 2016, whichever occurred first. Cox proportional hazards models were used for analyses. At least one incident fracture was sustained by 156 men and 135 women over a median(IQR) of 11.5(6.2-13.2) and 10.9(6.3-11.6) years of follow-up, respectively. In unadjusted analyses, compared to non-users without hypertension, men in all three other groups had a higher risk of fracture (Hazard Ratio (HR, 95%CI) 1.54, 1.00-2.37; 1.90, 1.18-3.05; 2.15, 1.26-3.66), for non-users with hypertension, ACEI and ARB users, respectively). Following adjustment for age, prior fracture and BMD, these associations became non-significant. A dose effect for ARB use was observed; men using lower doses had a higher risk of fracture than non-users without hypertension, in both unadjusted (2.66, 1.34-5.29) and adjusted (2.03, 1.01-4.08) analyses, but this association was not observed at higher doses. For women, unadjusted analyses showed a higher risk for ACEI users compared to non-users without hypertension (1.74, 1.07-2.83). This was explained after adjustment for age, alcohol consumption, prior fracture and BMD (1.28, 0.74-2.22). No other differences were observed. In men, lower dose (0 < DDD ≤ 1) ARB use was associated with an increased risk of fracture. ACEI or ARB use was not associated with increased risk of incident fracture in women. These findings may be important for antihypertensive treatment decisions in individuals with a high risk of fracture.
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Affiliation(s)
- Kara L Holloway-Kew
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Health Education and Research Building, Level 3 (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia.
| | - Amelia G Betson
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Health Education and Research Building, Level 3 (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
| | - Kara B Anderson
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Health Education and Research Building, Level 3 (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
| | - Filip Sepetavc
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Health Education and Research Building, Level 3 (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
| | - James Gaston
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Health Education and Research Building, Level 3 (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
| | - Mark A Kotowicz
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Health Education and Research Building, Level 3 (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
- Barwon Health, Geelong, Australia
- Department of Medicine, The University of Melbourne - Western Health, St Albans, Australia
| | - Wan-Hui Liao
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Internal Medicine, Taipei City Hospital Yangming Branch, Taipei, Taiwan
| | - Maciej Henneberg
- Biological and Comparative Anatomy Research Unit, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
- Department of Archaeology, Flinders University, Adelaide, Australia
| | - Julie A Pasco
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Health Education and Research Building, Level 3 (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
- Barwon Health, Geelong, Australia
- Department of Medicine, The University of Melbourne - Western Health, St Albans, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia
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Liampas I, Hatzimanolis A, Siokas V, Yannakoulia M, Kosmidis MH, Sakka P, Hadjigeorgiou GM, Scarmeas N, Dardiotis E. Antihypertensive Medication Class and the Risk of Dementia and Cognitive Decline in Older Adults: A Secondary Analysis of the Prospective HELIAD Cohort. J Alzheimers Dis 2022; 89:709-719. [PMID: 35912747 DOI: 10.3233/jad-220439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is unclear whether the main antihypertensive medication classes (diuretics, calcium channel blockers, beta-blockers, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers (ARBs)) are associated with different risks of cognitive decline. Published evidence is conflicting and stems mainly from observational studies. OBJECTIVE To investigate the differential effects of antihypertensives on the risks of developing dementia and cognitive decline, with a specific focus on the vascular component of the mechanisms underlying these interactions. METHODS Older adults with a history of hypertension and without dementia were drawn from the population-based HELIAD cohort. Age-, gender-, education-, and antihypertensive medication- (five dichotomous exposures) adjusted Cox proportional-hazards models and generalized estimating equations were performed to appraise the associations of baseline antihypertensive therapy with dementia incidence and cognitive decline (quantified using a comprehensive neuropsychological battery). Analyses were subsequently adjusted for clinical vascular risk (dyslipidemia, diabetes mellitus, smoking, cardiovascular, and cerebrovascular history) and genetic susceptibility to stroke (using polygenic risk scores generated according to the MEGASTROKE consortium GWAS findings). RESULTS A total of 776 predominantly female participants (73.61±4.94 years) with hypertension and a mean follow-up of 3.02±0.82 years were analyzed. Baseline treatment was not associated with the risk of incident dementia. ARB users experienced a slower yearly global cognitive [2.5% of a SD, 95% CI = (0.1, 4.9)] and language [4.4% of a SD, 95% CI = (1.4, 7.4)] decline compared to non-users. The fully adjusted model reproduced similar associations for both global cognitive [β= 0.027, 95% CI = (-0.003, 0.057)], and language decline [β= 0.063, 95% CI = (0.023, 0.104)]. CONCLUSION ARBs may be superior to other antihypertensive agents in the preservation of cognition, an association probably mediated by vascular-independent mechanisms.
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Affiliation(s)
- Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Alex Hatzimanolis
- Department of Psychiatry, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paraskevi Sakka
- Athens Association of Alzheimer's Disease and Related Disorders, Marousi, Athens, Greece
| | - Georgios M Hadjigeorgiou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece.,Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.,Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY, USA
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
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Umeukeje EM, Washington JT, Nicholas SB. Etiopathogenesis of kidney disease in minority populations and an updated special focus on treatment in diabetes and hypertension. J Natl Med Assoc 2022; 114:S3-S9. [PMID: 35589418 DOI: 10.1016/j.jnma.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Diabetes and hypertension are the most common causes of chronic kidney disease (CKD) in the general population as well as in the Black and African American population, who also suffer from high rates of CKD and CKD progression compared to the White population. Progression of CKD can lead to kidney failure, and patients with progressive kidney disease have a high risk of premature mortality, particularly from cardiovascular disease. Screening for early detection of CKD is important as it facilitates the initiation of medications that have been shown to delay the progression of diabetes-related as well as non-diabetes-related CKD, and reduce rates of death from both kidney and cardiovascular disease. The potential adverse effects from use of some of the newer reno- and cardio-protective glucose-lowering medications, such as the sodium glucose cotransporter-2 inhibitors, may be effectively avoided with detailed patient education and monitoring by the healthcare provider. It is important to note that lifestyle modification including regular exercise, diet, and smoking cessation are first-line in the management of diabetes and hypertension. When CKD occurs, co-management by providers using a comprehensive strategy may avert early complications and facilitate appropriate early referral for nephrology specialty care.
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Affiliation(s)
- Ebele M Umeukeje
- Division of Nephrology, Vanderbilt University Medical Center, Vanderbilt Center for Kidney Disease, United States
| | | | - Susanne B Nicholas
- David Geffen School of Medicine at University of California, 7-155 Factor Bldg. 10833 LeConte Blvd, Los Angeles, CA 90095, United States.
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Noubiap JJ, Nouthe B, Sia YT, Spaziano M. Effect of preoperative renin-angiotensin system blockade on vasoplegia after cardiac surgery: A systematic review with meta-analysis. World J Cardiol 2022; 14:250-259. [PMID: 35582469 PMCID: PMC9048276 DOI: 10.4330/wjc.v14.i4.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/09/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vasoplegia is a common complication of cardiac surgery but its causal relationship with preoperative use of renin angiotensin system (RAS) blockers [angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARB)] is still debated.
AIM To update and summarize data on the effect of preoperative use of RAS blockers on incident vasoplegia.
METHODS All published studies from MEDLINE, EMBASE, and Web of Science providing relevant data through January 13, 2021 were identified. A random-effects meta-analysis method was used to pool estimates, and post-cardiac surgery shock was differentiated from vasoplegia.
RESULTS Ten studies reporting on a pooled population of 15672 patients (none looking at ARBs exclusively) were included in the meta-analysis. All were case-control studies. Use of ACEIs was associated with an increased risk of vasoplegia [pooled adjusted odds ratio (Aor) of 2.06, 95%CI: 1.45-2.93] and increased inotropic/vasopressor support requirement (pooled aOR 1.19, 95%CI: 1.10-1.29). Post-cardiac surgery shock was increased in the presence of left ventricular dysfunction (pooled aOR 2.32, 95%CI: 1.60-3.36; I2 49%) but not increased by the use of beta blockers (pooled aOR 0.78, 95%CI: 0.36-1.69; I2 77%). Two randomized control trials (RCTs), not eligible for the meta-analysis, did not show an association between continuation of RAS blockers and vasoplegia.
CONCLUSION Preoperative continuation of ACEIs is associated with an increased need for inotropic support postoperatively and with an increased risk of vasoplegia in observational studies but not in RCTs. The absence of a consensus definition of vasoplegia should lead to the use of perioperative cardiovascular monitoring when designing RCTs to better understand this discrepancy.
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Affiliation(s)
- Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Brice Nouthe
- Department of Medicine, University of British Columbia, Vancouver V6T 1W5, Canada
| | - Ying Tung Sia
- Department of Medicine, Regional Trois-Rivières Hospital (CIUSSS-MCQ), Trois-Rivières 5000, Canada
| | - Marco Spaziano
- Department of Cardiology, McGill University Health Centre, Montréal QC H4A 3J1, Canada
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12
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Abstract
INTRODUCTION Angiotensin converting enzyme inhibitors (ACEI) are commonly used for cardiovascular diseases. The evidence supporting the use of ACEI in dermatology is limited. AREAS COVERED This review article was divided into three parts. The first part discusses ACEI in clinical use in dermatology. The second part reveals the relationship between angiotensin converting enzyme (ACE) and immune diseases, and further discusses the possible relationship between ACEI in clinical use in these diseases and ACE. The third part focuses on cutaneous adverse reactions of ACEI. EXPERT OPINION The use of ACEI in dermatology is mainly based on its properties as regulation of renin angiotensin system (RAS), but currently, with limited clinical use. The association of ACE and several diseases are well discussed, including COVID-19, psoriasis, sarcoidosis, systemic lupus erythematosus and vitiligo. The main cutaneous adverse effects of ACEI include angioedema, psoriasis and pemphigus. Plausible factors for these adverse reactions include accumulation of vasoactive mediators, preventing angiotension from binding to AT1 receptor and AT2 receptor and presence of circulating antibodies.
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Affiliation(s)
- Yang Lo
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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13
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LUZUM JASMINEA, EDOKOBI OZIOMA, DORSCH MICHAELP, PETERSON EDWARD, LIU BIN, GUI HONGSHENG, WILLIAMS LKEOKI, LANFEAR DAVIDE. Survival Association of Angiotensin Inhibitors in Heart Failure With Reduced Ejection Fraction: Comparisons Using Self-Identified Race and Genomic Ancestry. J Card Fail 2022; 28:215-225. [PMID: 34425222 PMCID: PMC9199310 DOI: 10.1016/j.cardfail.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/02/2021] [Revised: 07/20/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND It remains unclear whether there is a racial disparity in the response to angiotensin inhibitors in patients with heart failure with reduced ejection fraction (HFrEF) and whether the role of genomic ancestry plays a part. Therefore, we compared survival rates associated with angiotensin inhibitors in patients with HFrEF by self-identified race and proportion of West African genomic ancestry. METHODS Three datasets totaling 1153 and 1480 self-identified Black and White patients, respectively, with HFrEF were meta-analyzed (random effects model) for race-based analyses. One dataset had genomic data for ancestry analyses (416 and 369 self-identified Black and White patients, respectively). Cox proportional hazards regression, adjusted for propensity scores, assessed the association of angiotensin inhibitor exposure with all-cause mortality by self-identified race or proportion of West African genomic ancestry. RESULTS In meta-analysis of self-identified race, adjusted hazard ratios (95% CI) for exposure to angiotensin inhibitors were similar in self-identified Black and White patients with HFrEF: 0.52 (0.31-0.85) P = 0.006 and 0.54 (0.42-0.71) P = 0.001, respectively. Results were similar when the proportion of West African genomic ancestry was > 80% or < 5%: 0.66 (0.34-1.25) P = 0.200 and 0.56 (0.26-1.23) P = 0.147, respectively. CONCLUSIONS Among self-identified Black and White patients with HFrEF, reduction in all-cause mortality associated with exposure to angiotensin inhibitors was similar regardless of self-identified race or proportion of West African genomic ancestry.
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Affiliation(s)
- JASMINE A. LUZUM
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan,Center for Individualized and Genomic Medicine Research, Henry Ford Hospital, Detroit, Michigan
| | - OZIOMA EDOKOBI
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - MICHAEL P. DORSCH
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - EDWARD PETERSON
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - BIN LIU
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - HONGSHENG GUI
- Center for Individualized and Genomic Medicine Research, Henry Ford Hospital, Detroit, Michigan
| | - L. KEOKI WILLIAMS
- Center for Individualized and Genomic Medicine Research, Henry Ford Hospital, Detroit, Michigan,Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - DAVID E. LANFEAR
- Center for Individualized and Genomic Medicine Research, Henry Ford Hospital, Detroit, Michigan,Heart and Vascular Institute, Henry Ford Health System, Detroit, Michigan
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14
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Prosser HC, Peck KY, Dinh D, Roberts L, Chandrasekhar J, Brennan A, Duffy SJ, Clark D, Ajani AE, Oqueli E, Sebastian M, Reid CM, Freeman M, Sajeev JK, Teh AW. Role of renin-angiotensin system antagonists on long-term mortality post-percutaneous coronary intervention in reduced and preserved ejection fraction. Clin Res Cardiol 2022. [PMID: 35050405 DOI: 10.1007/s00392-021-01985-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/21/2021] [Indexed: 11/03/2022]
Abstract
AIMS The use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II-receptor blockers (ARBs) post-myocardial infarction (MI) is supported by evidence based on trials performed in the thrombolysis era. This was prior to primary percutaneous coronary intervention (PCI) being routine practice, and with little direct evidence for the use of these medications in patients with preserved left ventricular (LV) function. This study sought to determine whether there is an association between ACEi/ARB use after PCI for acute coronary syndrome (ACS) and long-term all-cause mortality, with a particular focus on patients with preserved LV function. METHODS This multicentre, observational study evaluated prospectively collected data of 21,388 patients (> 18 years old) that underwent PCI for NSTEMI and STEMI between 2005 and 2018, and were alive at 30 day follow-up. RESULTS In total, 83.8% of patients were using ACEi/ARBs. Kaplan-Meier analysis demonstrated ACEi/ARB use was associated with a significantly lower mortality in the entire cohort (15.0 vs. 22.7%; p < 0.001) with a mean follow-up of 5.58 years; and independently associated with 24% lower mortality by Cox proportional hazards modelling (HR 0.76, CI 0.67-0.85, p < 0.001). ACEi/ARB therapy was also associated with significantly lower mortality in patients with reduced or preserved LV function, with greater survival benefit with worse LV dysfunction. CONCLUSION ACEi/ARB therapy post-PCI is associated with significantly lower long-term mortality in patients with reduced and preserved LV function. These findings provide contemporary evidence for using these agents in the current era of routine primary PCI, including those with preserved EF.
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15
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Han J, Srisuwananukorn A, Shah BN, Molokie RE, Lash JP, Gordeuk VR, Saraf SL. Effects of Renin-Angiotensin Blockade and APOL1 on Kidney Function in Sickle Cell Disease. EJHaem 2021; 2:483-484. [PMID: 34604839 PMCID: PMC8482779 DOI: 10.1002/jha2.259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Jin Han
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL.,Division of Hematology & Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Andrew Srisuwananukorn
- Division of Hematology & Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Binal N Shah
- Division of Hematology & Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Robert E Molokie
- Division of Hematology & Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL.,Department of Medicine, Jesse Brown VA Medical Center, Chicago, IL
| | - James P Lash
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Victor R Gordeuk
- Division of Hematology & Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Santosh L Saraf
- Division of Hematology & Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
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16
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Garcia-Saucedo JC, Trejo-Gutierrez JF, Volcheck G, Park MA, Gonzalez-Estrada A. Incidence and Risk Factors of Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema: A Large Case-Control Study. Ann Allergy Asthma Immunol 2021; 127:591-592. [PMID: 34363973 DOI: 10.1016/j.anai.2021.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/14/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Juan C Garcia-Saucedo
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, FL, USA; Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, AZ, USA
| | - Jorge F Trejo-Gutierrez
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, USA; Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, AZ, USA
| | - Gerald Volcheck
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA; Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, AZ, USA
| | - Miguel A Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA; Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, AZ, USA
| | - Alexei Gonzalez-Estrada
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, FL, USA; Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, AZ, USA.
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17
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Sutton AL, Felix AS, Bandyopadhyay D, Retnam R, Hundley WG, Sheppard VB. Cardioprotective medication use in Black and white breast cancer survivors. Breast Cancer Res Treat 2021; 188:769-778. [PMID: 33797652 PMCID: PMC8277673 DOI: 10.1007/s10549-021-06202-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Racial disparities in cardiovascular disease and cardiac dysfunction exist amongst breast cancer survivors. This study examined the prevalence of cardioprotective medication use in survivors and identified factors associated with use by race. METHODS The analysis included women enrolled in the Women's Hormonal Initiation and Persistence study, a longitudinal observational trial of breast cancer survivors. The study outcome, angiotensin converting enzyme inhibitor (ACEi) or ß-Blocker (BB) use, were ascertained from pharmacy records. Demographic, psychosocial, healthcare, and quality of life factors were collected from surveys and clinical data were abstracted from medical records. Bivariate associations by race and ACEi/BB use were tested using chi square and t tests; logistic regression evaluated multivariable-adjusted associations. RESULTS Of the 246 survivors in the sample, 33.3% were Black and most were < 65 years of age (58.4%). Most survivors were hypertensive (57.6%) and one-third received ACEi/BBs. In unadjusted analysis, White women (vs. Black) (OR 0.33, 95% 0.19-0.58) and women with higher ratings of functional wellbeing (OR 0.94, 95% 0.89-0.99) were less likely to use ACEi/BBs. Satisfaction with provider communication was only significant for White women. In multivariable-adjusted analysis, ACEi/BB use did not differ by race. Correlates of ACEi/BB use included hypertension among all women and older age for Black women only. CONCLUSIONS After adjusting for age and comorbidities, no differences by race in ACEi/BB use were observed. Hypertension was a major contributor of ACEi/BB use in BC survivors.
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Affiliation(s)
- Arnethea L Sutton
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, P.O. Box 980149, Richmond, VA, 23219, USA.
| | - Ashley S Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Dipankar Bandyopadhyay
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Reuben Retnam
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - William G Hundley
- Department of Internal Medicine, Division of Cardiovascular Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, P.O. Box 980149, Richmond, VA, 23219, USA
- Office of Health Equity and Disparities Research, Massey Cancer Center, Richmond, VA, USA
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18
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An J, Zhou H, Wei R, Luong TQ, Gould MK, Mefford MT, Harrison TN, Creekmur B, Lee MS, Sim JJ, Brettler JW, Martin JP, Ong-Su AL, Reynolds K. COVID-19 morbidity and mortality associated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers use among 14,129 patients with hypertension from a US integrated healthcare system. Int J Cardiol Hypertens 2021; 9:100088. [PMID: 34155486 PMCID: PMC8204813 DOI: 10.1016/j.ijchy.2021.100088] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/07/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Although recent evidence suggests no increased risk of severe COVID-19 outcomes associated with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) use, the relationship is less clear among patients with hypertension and diverse racial/ethnic groups. This study evaluates the risk of hospitalization and mortality among patients with hypertension and COVID-19 in a large US integrated healthcare system. METHODS Patients with hypertension and COVID-19 (between March 1- September 1, 2020) on ACEIs or ARBs were compared with patients on other frequently used antihypertensive medications. RESULTS Among 14,129 patients with hypertension and COVID-19 infection (mean age 60 years, 48% men, 58% Hispanic), 21% were admitted to the hospital within 30 days of COVID-19 infection. Of the hospitalized patients, 24% were admitted to intensive care units, 17% required mechanical ventilation, and 10% died within 30 days of COVID-19 infection. Exposure to ACEIs or ARBs prior to COVID-19 infection was not associated with an increased risk of hospitalization or all-cause mortality (rate ratios for ACEIs vs other antihypertensive medications = 0.98, 95% CI: 0.88, 1.08; ARBs vs others = 1.00, 95% CI: 0.90, 1.11) after applying inverse probability of treatment weights. These associations were consistent across racial/ethnic groups. Use of ACEIs or ARBs during hospitalization was associated with a lower risk of all-cause mortality (odds ratios for ACEIs or ARBs vs others = 0.50, 95% CI: 0.34, 0.72). CONCLUSION Our study findings support continuation of ACEI or ARB use for patients with hypertension during the COVID-19 pandemic and after COVID-19 infection.
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Affiliation(s)
- Jaejin An
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Hui Zhou
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Rong Wei
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Tiffany Q. Luong
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Michael K. Gould
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Matthew T. Mefford
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Teresa N. Harrison
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Beth Creekmur
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Ming-Sum Lee
- Southern California Permanente Medical Group, Pasadena, CA, USA
| | - John J. Sim
- Southern California Permanente Medical Group, Pasadena, CA, USA
| | | | - John P. Martin
- Southern California Permanente Medical Group, Pasadena, CA, USA
| | | | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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19
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Lo KB, Toroghi HM, Salacup G, Jiang J, Bhargav R, Quintero E, Balestrini K, Shahzad A, Mathew RO, McCullough PA, Rangaswami J. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers in acute heart failure: invasive hemodynamic parameters and clinical outcomes. Rev Cardiovasc Med 2021; 22:199-206. [PMID: 33792263 DOI: 10.31083/j.rcm.2021.01.216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/15/2020] [Revised: 11/27/2020] [Accepted: 12/08/2020] [Indexed: 11/06/2022] Open
Abstract
There are limited data regarding the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) in acute heart failure (AHF). The purpose is to determine the patterns of ACEi/ARB use at the time of admission and discharge in relation to invasive hemodynamic data, mortality, and heart failure (HF) readmissions. This is a retrospective single-center study in patients with AHF who underwent right heart catheterization between January 2010 and December 2016. Patients on dialysis, evidence of shock, or incomplete follow up were excluded. Multivariate logistic regression analysis was used to analyze the factors associated with continuation of ACEi/ARB use on discharge and its relation to mortality and HF readmissions. The final sample was 626 patients. Patients on ACEi/ARB on admission were most likely continued on discharge. The most common reasons for stopping ACEi/ARB were worsening renal function (WRF), hypotension, and hyperkalemia. Patients with ACEi/ARB use on admission had a significantly higher systemic vascular resistance (SVR) and mean arterial pressure (MAP), but lower cardiac index (CI). Patients with RA pressures above the median received less ACEi/ARB (P = 0.025) and had significantly higher inpatient mortality (P = 0.048). After multivariate logistic regression, ACEi/ARB use at admission was associated with less inpatient mortality; OR 0.32 95% CI (0.11 to 0.93), and this effect extended to the subgroup of patients with HFpEF. Patients discharged on ACEi/ARB had significantly less 6-month HF readmissions OR 0.69 95% CI (0.48 to 0.98). ACEi/ARB use on admission for AHF was associated with less inpatient mortality including in those with HFpEF.
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Affiliation(s)
- Kevin Bryan Lo
- Department of Internal Medicine, Einstein Medical Center, 19141 Philadelphia, USA
| | | | - Grace Salacup
- Department of Internal Medicine, Einstein Medical Center, 19141 Philadelphia, USA
| | - Jiahui Jiang
- Department of Internal Medicine, Einstein Medical Center, 19141 Philadelphia, USA
| | - Ruchika Bhargav
- Department of Internal Medicine, Einstein Medical Center, 19141 Philadelphia, USA
| | - Eduardo Quintero
- Department of Internal Medicine, Einstein Medical Center, 19141 Philadelphia, USA
| | - Kira Balestrini
- Department of Internal Medicine, Einstein Medical Center, 19141 Philadelphia, USA
| | - Anum Shahzad
- Department of Internal Medicine, Einstein Medical Center, 19141 Philadelphia, USA
| | - Roy O Mathew
- Division of Nephrology, Columbia VA Health Care System, Columbia, SC 29209, USA
| | - Peter A McCullough
- Baylor University Medical Center, 75226 Dallas, USA.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Baylor Heart and Vascular Institute, 75226 Dallas, USA
| | - Janani Rangaswami
- Department of Medicine, Division of Nephrology, Einstein Medical Center, 19141 Philadelphia, USA.,Sidney Kimmel College of Thomas Jefferson University, 19107 Philadelphia, USA
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20
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Nguyen M, Rumjaun S, Lowe‐Jones R, Ster IC, Rosano G, Anderson L, Banerjee D. Management and outcomes of heart failure patients with CKD: experience from an inter-disciplinary clinic. ESC Heart Fail 2020; 7:3225-3230. [PMID: 32652822 PMCID: PMC7524254 DOI: 10.1002/ehf2.12796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/09/2020] [Accepted: 05/13/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS CKD-HF patients suffer excess hospitalization and mortality, often under-treated with life-prolonging medications due to fear of worsening renal function and hyperkalaemia. Yet, role of inter-disciplinary working in improving therapy is unknown, which this study aims to investigate. METHODS AND RESULTS Clinical, biochemical data, and medications at first and last clinic visit were obtained from patient records for 124 patients seen in kidney failure-heart failure clinic (23 March 2017 to 11 April 2019). Medication dose groups (none, low, and high dose), number of RAASi agents, and blood test results were compared between first and last visit in patients with at least two clinic visits (n = 97). Patient characteristics were age 78.5 years (IQR 68.1-84.4 years), male 67.7%, diabetes 51.6%, moderate (45.2%) vs. severe (39.5%) CKD, HF with reduced ejection fraction (HFrEF) (49.2%), follow-up 234 days (IQR 121-441 days). HFrEF was associated with increased risk of death (adjusted OR 4.49, 95% CI 1.43-14.05; P = 0.01). Distributions of patients according to number of RAASi agents they were on differed between first and last visit (P = 0.03). Dosage was increased in 25.9% for beta-blockers, 33.0% for ACEi/ARBs, and 17.5% for MRAs. Distributions of patients across MRA dosage groups was different (P = 0.03), with higher proportions on higher dosages at last visit, without significant changes in serum potassium or creatinine. Serum ferritin improved (131.0 vs. 267.5 μg/L; P < 0.001), and fewer patients had iron deficiency (56.7% vs. 26.8%; P = 0.002) at last visit compared to the first. CONCLUSIONS This inter-disciplinary clinic improved guideline-recommended medication prescription, MRA dosages in CKD-HF patients without significant biochemical abnormality, and iron status. A prospectively designed study with medication titration protocol and defined patient-centred outcomes is needed to further assess effectiveness of such clinic.
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Affiliation(s)
- Mai Nguyen
- Renal and Transplantation UnitSt George's University Hospital NHS Foundation TrustLondonUK
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research InstituteSt George's, University of London, St George's HospitalGrosvenor Wing Room 2.113, Blackshaw Road, TootingLondonSW170QTUK
| | - Samir Rumjaun
- Renal and Transplantation UnitSt George's University Hospital NHS Foundation TrustLondonUK
| | - Racquel Lowe‐Jones
- Renal and Transplantation UnitSt George's University Hospital NHS Foundation TrustLondonUK
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research InstituteSt George's, University of London, St George's HospitalGrosvenor Wing Room 2.113, Blackshaw Road, TootingLondonSW170QTUK
| | - Irina Chis Ster
- Institute of Infection and ImmunitySt George's, University of LondonLondonUK
| | - Giuseppe Rosano
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research InstituteSt George's, University of London, St George's HospitalGrosvenor Wing Room 2.113, Blackshaw Road, TootingLondonSW170QTUK
| | - Lisa Anderson
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research InstituteSt George's, University of London, St George's HospitalGrosvenor Wing Room 2.113, Blackshaw Road, TootingLondonSW170QTUK
| | - Debasish Banerjee
- Renal and Transplantation UnitSt George's University Hospital NHS Foundation TrustLondonUK
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research InstituteSt George's, University of London, St George's HospitalGrosvenor Wing Room 2.113, Blackshaw Road, TootingLondonSW170QTUK
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21
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RAAS inhibitors are not associated with mortality in COVID-19 patients: Findings from an observational multicenter study in Italy and a meta-analysis of 19 studies. Vascul Pharmacol 2020; 135:106805. [PMID: 32992048 PMCID: PMC7521934 DOI: 10.1016/j.vph.2020.106805] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022]
Abstract
Objective The hypothesis that been set forward that use of Renin Angiotensin Aldosterone System (RAAS) inhibitors is associated with COVID−19 severity. We set-up a multicenter Italian collaboration (CORIST Project, ClinicalTrials.gov ID: NCT04318418) to retrospectively investigate the relationship between RAAS inhibitors and COVID−19 in-hospital mortality. We also carried out an updated meta-analysis on the relevant studies. Methods We analyzed 4069 unselected patients with laboratory-confirmed SARS-CoV-2 infection and hospitalized in 34 clinical centers in Italy from February 19, 2020 to May 23, 2020. The primary end-point in a time-to event analysis was in-hospital death, comparing patients who received angiotensin-converting–enzyme inhibitors (ACE—I) or angiotensin-receptor blockers (ARB) with patients who did not. Articles for the meta-analysis were retrieved until July 13th, 2020 by searching in web-based libraries, and data were combined using the general variance-based method. Results Out of 4069 COVID−19 patients, 13.5% and 13.3% received ACE-I or ARB, respectively. Use of neither ACE-I nor ARB was associated with mortality (multivariable hazard ratio (HR) adjusted also for COVID−19 treatments: 0.96, 95% confidence interval 0.77–1.20 and HR = 0.89, 0.67–1.19 for ACE-I and ARB, respectively). Findings were similar restricting the analysis to hypertensive (N = 2057) patients (HR = 1.00, 0.78–1.26 and HR = 0.88, 0.65–1.20) or when ACE-I or ARB were considered as a single group. Results from the meta-analysis (19 studies, 29,057 COVID−19 adult patients, 9700 with hypertension) confirmed the absence of association. Conclusions In this observational study and meta-analysis of the literature, ACE-I or ARB use was not associated with severity or in-hospital mortality in COVID−19 patients.
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Kim GS, Ko YG, Suh Y, Won H, Hong SJ, Ahn CM, Kim JS, Kim BK, Choi D, Hong MK, Jang Y. Impact of Angiotensin II Receptor Blockers on Clinical Outcomes after Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction Based on Data from the Korean National Health Insurance Database (2005-2014). Korean Circ J 2020; 50:984-994. [PMID: 32725998 PMCID: PMC7596207 DOI: 10.4070/kcj.2020.0057] [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] [Received: 02/08/2020] [Revised: 06/02/2020] [Accepted: 06/26/2020] [Indexed: 12/31/2022] Open
Abstract
Background and Objectives The effectiveness of angiotensin II receptor blockers (ARBs) compared with angiotensin converting enzyme inhibitors (ACEIs) in patients with acute myocardial infarction (AMI) has not been established. We investigated the effects of ARBs on clinical outcomes after percutaneous coronary intervention (PCI) in AMI patients. Methods Patients receiving ACEIs or ARBs after AMI treated with PCI between January 2005 and December 2014 were selected from the Korean National Health Insurance Service database. The primary endpoint was major cardiovascular adverse event (MACE; all-cause death, myocardial infarct [MI], or stroke). Results We included patients regularly taking ACEIs (n=22,331) or ARBs (n=28,533) (medication possession ratio ≥80%). Compared with the ACEI group, the ARB group contained more females (31% vs. 18%), were older (mean, 63 vs. 60 years), and had more comorbidities, including hypertension (62.8% vs. 44.8%), diabetes (33.9% vs. 26.4%), congestive heart failure (7.9% vs. 4.3%), chronic obstructive pulmonary disease (25.5% vs. 18.9%), and end-stage renal disease (1.3% vs. 0.4%) (p<0.001 for all). After propensity score–matching, ARBs were associated with a 23% lower risk of MACE (hazard ratio [HR], 0.774; 95% confidence interval [CI], 0.715–0.838; p<0.001) than ACEIs. ARB use was also associated with a significantly reduced risk of death (HR, 0.741; 95% CI, 0.659–0.834; p<0.001), MI (HR, 0.731; 95% CI, 0.638–0.837; p<0.001), and revascularization (HR, 0.816; 95% CI, 0.773–0.861; p<0.001). Conclusions ARB use was associated with a lower risk of MACE, MI, and revascularization than ACEIs in our retrospective analysis of AMI patients who underwent PCI.
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Affiliation(s)
- Gwang Sil Kim
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
| | - Yongsung Suh
- Department of Cardiology, Myeongji Hospital, Goyang, Korea
| | - Hoyoun Won
- Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Chul Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Jung Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Byeong Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Myeong Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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Al-Rifaie A, Khan MA, Ali A, Dube AK, Gleeson D, Hoeroldt B. Lisinopril-Induced Liver Injury: An Unusual Presentation and Literature Review. Eur J Case Rep Intern Med 2020; 7:001600. [PMID: 32665926 PMCID: PMC7350971 DOI: 10.12890/2020_001600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 11/05/2022] Open
Abstract
Lisinopril is an angiotensin converting enzyme inhibitor (ACE-I) that has been on market for more than 25 years. ACE-I are usually well tolerated and rarely have serious or life-threatening side effects. We describe an unusual presentation of fulminant hepatic cholestasis probably secondary to lisinopril. To our knowledge, this is the second case report which shows lisinopril-induced liver injury though a cholestatic mechanism. The patient was a 59-year-old woman with type 2 diabetes, a high body mass index and hypertension, who presented with a 5-week history of jaundice and itching. She had been started on lisinopril for diabetic nephropathy 8 weeks before admission. Other causes for cholestasis had been excluded through non-invasive immunology and virology screening, an ultrasound of the liver, magnetic resonance cholangiopancreatography and a liver biopsy. The biopsy was consistent with drug-induced liver injury. Lisinopril was stopped 2 weeks before admission. The patient's hospital stay was complicated by contrast nephropathy and influenza A which were both treated appropriately. Unfortunately, the liver cholestasis did not completely resolve following withdrawal of lisinopril and the patient died after 4 months. A literature search yielded only six other reported cases of lisinopril-induced liver injury. Five cases described hepatocellular damage and one showed cholestatic injury. LEARNING POINTS Angiotensin converting enzyme inhibitors (ACE-I) rarely have serious or life-threatening side effects.Lisinopril-induced liver injury can present as hepatocellular or cholestatic injury.Severe hepatotoxicity secondary to lisinopril can be life threatening irrespective of the liver injury pattern.
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Affiliation(s)
- Ammar Al-Rifaie
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mir Azam Khan
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Amjad Ali
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Asha Kumari Dube
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dermot Gleeson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Barbara Hoeroldt
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Azam C, Durrieu G, Deuilhe E, Lafaurie M. Amlodipine and perindopril-induced hypertrichosis in a six-year-old girl: A case report. Therapie 2020; 76:481-483. [PMID: 32653092 DOI: 10.1016/j.therap.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/13/2020] [Accepted: 06/22/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Camille Azam
- Service de pharmacologie médicale et clinique, faculté de médecine, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, CHU, 31000 Toulouse, France
| | - Geneviève Durrieu
- Service de pharmacologie médicale et clinique, faculté de médecine, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, CHU, 31000 Toulouse, France
| | | | - Margaux Lafaurie
- Service de pharmacologie médicale et clinique, faculté de médecine, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, CHU, 31000 Toulouse, France.
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Cure E, Cumhur Cure M. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be harmful in patients with diabetes during COVID-19 pandemic. Diabetes Metab Syndr 2020; 14:349-350. [PMID: 32311651 PMCID: PMC7159862 DOI: 10.1016/j.dsx.2020.04.019] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 02/07/2023]
Abstract
The novel coronavirus disease 2019 (COVID-19) outbreak once again demonstrated the importance of the renin-angiotensin system (RAS) in patients with diabetes. Activation of the RAS increases in patients with diabetes. The virus attaches to the ACE2 enzyme at low cytosolic pH values and enters into the cell and causes infection. Especially in the presence of diabetes mellitus and accompanying comorbid conditions such as hypertension, obesity, old age, and smoking, cytosolic pH is low, thus the virus easily may enter the cell by attaching to ACE2. ACEIs and ARBs lead to a reduction in angiotensin II level by increasing the ACE2 level, thus they cause a low cytosolic pH. Increased cardiac ACE2 levels due to ACEIs and ARBs can trigger cardiac arrhythmias and myocarditis by causing the virus to easily enter the heart tissue. There is ACE2 activity in the rostral ventrolateral medulla in the brain stem. The release of angiotensin 1-7 in the brain stem leads to the activation of the sympathetic nervous system. This activation causes systemic vasoconstriction and the patient's blood pressure increases. The most important event is the increased sympathetic activity via the central stimulation, this activity increases pulmonary capillary leaking, causing the ARDS. As the cytosolic pH, which is already low in patients with diabetes will decrease further with the mechanisms mentioned above, the viral load will increase and the infection will be exacerbated. As a result, the use of ACEIs and ARBs in patients with diabetes can lead to increased morbidity and mortality of COVID-19.
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Affiliation(s)
- Erkan Cure
- Department of Internal Medicine, Ota&Jinemed Hospital, Istanbul, Turkey.
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26
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Arnold RH. COVID-19 - Does This Disease Kill Due to Imbalance of the Renin Angiotensin System (RAS) Caused by Genetic and Gender Differences in the Response to Viral ACE 2 Attack? Heart Lung Circ 2020; 29:964-972. [PMID: 32564908 PMCID: PMC7247492 DOI: 10.1016/j.hlc.2020.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 03/28/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
Debate continues in the medical literature on the role of the renin angiotensin system (RAS) in Coronavirus disease 2019 (COVID-19) pathophysiology and the implications for the use of cardiovascular drugs acting on the RAS. Could these drugs - which include angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptors blockers (ARBs) - be harmful or potential key therapeutic agents in COVID-19? And, could potentially helpful measures be available and in plain view on the pharmacy shelf?
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Cappannoli L, Scacciavillani R, Iannaccone G, Anastasia G, Di Giusto F, Loria V, Aspromonte N. 2019 novel-coronavirus: Cardiovascular insights about risk factors, myocardial injury, therapy and clinical implications. Chronic Dis Transl Med 2020; 6:246-250. [PMID: 32837764 PMCID: PMC7293466 DOI: 10.1016/j.cdtm.2020.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Indexed: 01/08/2023] Open
Abstract
From December 31st, 2019, a novel highly pathogenic coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread worldwide, reaching at present the dimension of a pandemic. In addition to damaging the lungs, SARS-CoV-2 may also damage the heart and this is corroborated by the evidence that cardiovascular comorbidities are associated with a higher mortality and poor clinical outcomes in patient infected by the virus. During the infection myocardial injury, myocarditis and arrhythmias have also been reported, but the pathophysiological mechanisms of these complications are yet to be understood. Great attention is also being posed on the potential beneficial/harmful role of angiotensin converting enzyme (ACE) inhibitors, as far as the virus binds to ACE2 to infect cells, but evidences lack. Furthermore, SARS-CoV-2 can also affect the aspect of acute coronary syndromes, not only because these two distinct pathological entities share pathogenic aspects (such as the systemic inflammatory state and cytokine release), but also and above all for the consequences that the need to contain the infection has on the management of cardiological urgencies. The aim of this review was therefore to summarize the relationship between the virus and the cardiovascular system.
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Affiliation(s)
- Luigi Cappannoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Roberto Scacciavillani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Giulia Iannaccone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Gianluca Anastasia
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Federico Di Giusto
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Valentina Loria
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Nadia Aspromonte
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
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Saheb Sharif-Askari N, Saheb Sharif-Askari F, Al Heialy S, Hamoudi R, Kashour T, Hamid Q, Halwani R. Cardiovascular medications and regulation of COVID-19 receptors expression. Int J Cardiol Hypertens 2020; 6:100034. [PMID: 33447763 PMCID: PMC7803030 DOI: 10.1016/j.ijchy.2020.100034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/30/2020] [Accepted: 06/05/2020] [Indexed: 01/09/2023]
Abstract
Introduction Emerging epidemiological studies suggested that Renin–Angiotensin–Aldosterone system (RAAS) inhibitors may increase infectivity and severity of COVID-19 by modulating the expression of ACE2. Methods In silico analysis was conducted to compare the blood expression levels of SARS-CoV-2 entry genes between age and gender matched cohort of hypertensive patients versus control, and to determine the effect of common cardiovascular medications on the expression of COVID-19 receptors in vitro using primary human hepatocytes. Results The transcriptomic analysis revealed a significant increase of ACE2 and TMPRSS2 in the blood of patients with hypertension. Treatment of primary human hepatocytes with captopril, but not enalapril, significantly increased ACE2 expression. A similar pattern of ACE2 expression was found following the in vitro treatments of rat primary cells with captopril and enalapril. Telmisartan, a second class RAAS inhibitors, did not affect ACE2 levels. We have also tested other cardiovascular medications that may be used alone, or in combination with RAAS inhibitors. Some of these medications increased TMPRSS2, while others, like furosemide, significantly reduced COVID-19 receptors. Conclusions The increase in ACE2 expression levels could be due to chronic use of RAAS inhibitors or alternatively caused by other hypertension-related factors or presence of other comorbidities. Treatment of common co-morbidities often require chronic use of multiple medications, which may result in an additive increase in the expression of ACE2 and TMPRSS2. Our data suggest that more research is needed to determine the effect of different medications, as well as medication combinations, on COVID-19 receptors. ACE2 and TMPRSS2 are the main cell entry receptors of SARS-CoV-2. These entry receptors are increased in the blood of patients with hypertension. This increase could be due to hypertension-related factors or the chronic use of RAAS inhibitors. RAAS inhibitors may increase infectivity of COVID-19 by modulating the expression of ACE2.
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Affiliation(s)
- Narjes Saheb Sharif-Askari
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Fatemeh Saheb Sharif-Askari
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Saba Al Heialy
- College of Medicine, Mohammed Bin Rashid University, Dubai, United Arab Emirates
- Meakins-Christie Laboratories, Research Institute of the McGill University Healthy Center, Montreal, Quebec, Canada
| | - Rifat Hamoudi
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Tarek Kashour
- Department of Cardiology, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Qutayba Hamid
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Meakins-Christie Laboratories, Research Institute of the McGill University Healthy Center, Montreal, Quebec, Canada
| | - Rabih Halwani
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Prince Abdullah Ben Khaled Celiac Disease Research Chair, Department of Pediatrics, Faculty of Medicine, King Saud University, Saudi Arabia
- Corresponding author. College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
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Abstract
An outbreak related to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, China in December 2019. An extremely high potential for dissemination resulted in the global coronavirus disease 2019 (COVID-19) pandemic in 2020. Despite the worsening trends of COVID-19, no drugs are validated to have significant efficacy in clinical treatment of COVID-19 patients in large-scale studies. Remdesivir is considered the most promising antiviral agent; it works by inhibiting the activity of RNA-dependent RNA polymerase (RdRp). A large-scale study investigating the clinical efficacy of remdesivir (200 mg on day 1, followed by 100 mg once daily) is on-going. The other excellent anti-influenza RdRp inhibitor favipiravir is also being clinically evaluated for its efficacy in COVID-19 patients. The protease inhibitor lopinavir/ritonavir (LPV/RTV) alone is not shown to provide better antiviral efficacy than standard care. However, the regimen of LPV/RTV plus ribavirin was shown to be effective against SARS-CoV in vitro. Another promising alternative is hydroxychloroquine (200 mg thrice daily) plus azithromycin (500 mg on day 1, followed by 250 mg once daily on day 2-5), which showed excellent clinical efficacy on Chinese COVID-19 patients and anti-SARS-CoV-2 potency in vitro. The roles of teicoplanin (which inhibits the viral genome exposure in cytoplasm) and monoclonal and polyclonal antibodies in the treatment of SARS-CoV-2 are under investigation. Avoiding the prescription of non-steroidal anti-inflammatory drugs, angiotensin converting enzyme inhibitors, or angiotensin II type I receptor blockers is advised for COVID-19 patients.
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Affiliation(s)
- Shio-Shin Jean
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Emergency Medicine, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Children's Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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30
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Montastruc F, Romano C, Montastruc JL, Silva S, Seguin T, Minville V, Georges B, Riu-Poulenc B, Fourcade O. Pharmacological characteristics of patients infected with SARS-Cov-2 admitted to Intensive Care Unit in South of France. Therapie 2020; 75:381-4. [PMID: 32425250 DOI: 10.1016/j.therap.2020.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 01/16/2023]
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Bidulka P, Iwagami M, Mansfield KE, Kalogirou F, Wong AYS, Douglas IJ, Smeeth L, Summers C, Tomlinson LA. Comparisons of Staphylococcus aureus infection and other outcomes between users of angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers: lessons for COVID-19 from a nationwide cohort study. Wellcome Open Res 2020; 5:77. [PMID: 32529041 PMCID: PMC7262569 DOI: 10.12688/wellcomeopenres.15873.1] [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] [Accepted: 04/22/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Mice receiving angiotensin converting enzyme inhibitor (ACEI) drugs show increased susceptibility to infection by
Staphylococcus aureus (
S. aureus). We sought to investigate whether humans using ACEI were at increased risk of
S. aureus infection, comparing them to users of Angiotensin II Receptor Blockers (ARB) with multiple control outcomes to assess the potential for residual confounding. Methods: Using the UK Clinical Practice Research Datalink linked to Hospital Episode Statistics between 1997 and 2017, we identified adults starting ACEI or ARB (as an active comparator drug). We regarded prescription of ACEI or ARB as time-dependent exposure and used a Cox regression model to compare incidence of first hospitalisation with infection due to
S. aureus in periods with ACEI to periods with ARB prescriptions. We repeated the analysis using control outcomes that we did not expect to be associated with use of ACEI versus ARB (Gram-negative sepsis, hip fracture and herpes zoster) and one that we did (dry cough). Results: We identified 445,341 new users of ACEI (mean age 64.0±14.0, male 51.7%) and 41,824 new users of ARB (mean age 64.1±14.0, male 45.5%). The fully adjusted hazard ratio for
S. aureus infection (ACEI vs. ARB) was 1.18 (95% CI 1.10–1.27), consistent across sensitivity analyses. However, we also found associations with all control outcomes; rates of Gram-negative sepsis, hip fracture and dry cough were also increased during periods of time treated with ACEI compared to ARB while herpes zoster was more common during time treated with ARB. Conclusions: Our results suggest that although ARB users appear an ideal control for analyses of ACEI effects, there is residual confounding even after multivariable adjustment. This has implications for observational analyses comparing users of these drug classes, in particular the effect of these drugs in relation to COVID-19 infection.
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Affiliation(s)
- Patrick Bidulka
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Masao Iwagami
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Fotini Kalogirou
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Angel Y S Wong
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ian J Douglas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Summers
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Laurie A Tomlinson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Dhawan R, Gundry RL, Brett-Major DM, Mahr C, Thiele GM, Lindsey ML, Anderson DR. COVID-19 and cardiovascular disease: What we know, what we think we know, and what we need to know. J Mol Cell Cardiol 2020; 144:12-14. [PMID: 32339565 PMCID: PMC7180349 DOI: 10.1016/j.yjmcc.2020.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/21/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Rahul Dhawan
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Rebekah L Gundry
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America; Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - David M Brett-Major
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Claudius Mahr
- Division of Cardiology, University of Washington, Seattle, WA, United States of America
| | - Geoffrey M Thiele
- Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, United States of America; Research Service, Nebraska-Western Iowa Health Care System, Omaha, NE, United States of America
| | - Merry L Lindsey
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States of America; Research Service, Nebraska-Western Iowa Health Care System, Omaha, NE, United States of America
| | - Daniel R Anderson
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America.
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Cure E, Cumhur Cure M. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be harmful in patients with diabetes during COVID-19 pandemic. Diabetes Metab Syndr 2020. [PMID: 32311651 DOI: 10.1016/j.dsx.2020.04.019.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) outbreak once again demonstrated the importance of the renin-angiotensin system (RAS) in patients with diabetes. Activation of the RAS increases in patients with diabetes. The virus attaches to the ACE2 enzyme at low cytosolic pH values and enters into the cell and causes infection. Especially in the presence of diabetes mellitus and accompanying comorbid conditions such as hypertension, obesity, old age, and smoking, cytosolic pH is low, thus the virus easily may enter the cell by attaching to ACE2. ACEIs and ARBs lead to a reduction in angiotensin II level by increasing the ACE2 level, thus they cause a low cytosolic pH. Increased cardiac ACE2 levels due to ACEIs and ARBs can trigger cardiac arrhythmias and myocarditis by causing the virus to easily enter the heart tissue. There is ACE2 activity in the rostral ventrolateral medulla in the brain stem. The release of angiotensin 1-7 in the brain stem leads to the activation of the sympathetic nervous system. This activation causes systemic vasoconstriction and the patient's blood pressure increases. The most important event is the increased sympathetic activity via the central stimulation, this activity increases pulmonary capillary leaking, causing the ARDS. As the cytosolic pH, which is already low in patients with diabetes will decrease further with the mechanisms mentioned above, the viral load will increase and the infection will be exacerbated. As a result, the use of ACEIs and ARBs in patients with diabetes can lead to increased morbidity and mortality of COVID-19.
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Affiliation(s)
- Erkan Cure
- Department of Internal Medicine, Ota&Jinemed Hospital, Istanbul, Turkey.
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Marathias KP, Lambadiari VA, Markakis KP, Vlahakos VD, Bacharaki D, Raptis AE, Dimitriadis GD, Vlahakos DV. Competing Effects of Renin Angiotensin System Blockade and Sodium-Glucose Cotransporter-2 Inhibitors on Erythropoietin Secretion in Diabetes. Am J Nephrol 2020; 51:349-356. [PMID: 32241009 DOI: 10.1159/000507272] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/14/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Anaemia is a common finding in diabetes, particularly in those patients with albuminuria or renal dysfunction and is associated with impaired erythropoietin (EPO) secretion. This review focuses on mechanisms involved in the regulation of erythropoiesis in diabetic patients in an effort to elucidate the competing effects of the renin angiotensin system (RAS) blockade and sodium-glucose cotransporter-2 (SGLT2) inhibitors on haemoglobin concentration and hematocrit values. SUMMARY The RAS shows significant activation in diabetic subjects. Angiotensin II, its active octapeptide, causes renal tubulointerstitial hypoxia, which stimulates hypoxia-inducible factors (HIF) and increases EPO secretion and erythropoiesis. As expected, drugs that inactivate RAS, such as angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEi/ARB) are associated with a significant hematocrit-lowering effect and/or anaemia in various clinical conditions, including diabetes. Dual blockade by a combination of ACEi and ARB in diabetic patients achieves a better RAS inhibition, but at the same time a worse drop of haemoglobin concentration. Increased glucose reabsorption by SGLTs in diabetic subjects generates a high-glucose environment in renal tubulointerstitium, which may impair HIF-1, damage renal erythropoietin-producing cells (REPs) and decrease EPO secretion and erythropoiesis. SGLT2 inhibitors, which inhibit glucose reabsorption, may attenuate glucotoxicity in renal tubulointerstitium, allowing REPs to resume their function and increase EPO secretion. Indeed, EPO levels increase within a few weeks after initiation of therapy with all known SGLT2 inhibitors, followed by increased reticulocyte count and a gradual elevation of haemoglobin concentration and hematocrit level, which reach zenith values after 2-3 months. Key Messages: The competing effects of RAS blockade and SGLT2 inhibitors on erythropoiesis may have important clinical implications. The rise of hematocrit values by SGLT2 inhibitors given on top of RAS blockade in recent outcome trials may significantly contribute to the cardiorenal protection attained. The relative contribution of each system to erythropoiesis and outcome remains to be revealed in future studies.
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Affiliation(s)
| | - Vaia A Lambadiari
- 2nd Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Centre, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Konstantinos P Markakis
- 2nd Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Centre, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Vassilios D Vlahakos
- Department of Pulmonary and Critical Care Services, Evangelismos Hospital, Athens, Greece
| | - Dimitra Bacharaki
- 2nd Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Centre, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Athanasios E Raptis
- 2nd Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Centre, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - George D Dimitriadis
- 2nd Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Centre, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Demetrios V Vlahakos
- 2nd Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Centre, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece,
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Yoon U, Setren AJ, Chen A, Nguyen T, Torjman MC, Kennedy TL. Continuation of angiotensin converting enzyme inhibitors on the day of surgery is not associated with increased risk of hypotension upon induction of general anesthesia in elective non-cardiac surgeries. J Clin Anesth 2020; 60:105-6. [PMID: 31536870 DOI: 10.1016/j.jclinane.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/28/2019] [Accepted: 09/10/2019] [Indexed: 11/21/2022]
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Moey MYY, Liles DK, Carabello BA. Concomitant use of renin-angiotensin-aldosterone system inhibitors prevent trastuzumab-induced cardiotoxicity in HER2+ breast cancer patients: an institutional retrospective study. Cardiooncology 2019; 5:9. [PMID: 32154015 PMCID: PMC7048102 DOI: 10.1186/s40959-019-0043-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/26/2019] [Indexed: 12/16/2022]
Abstract
Background Cardiotoxicity is an adverse effect of trastuzumab (TRA) in the treatment of human epidermal growth factor 2 positive (HER2+) breast cancer. Current literature on the cardioprotective effects of agents targeted against the renin-angiotensin-aldosterone system (RAAS) and beta-blockers (BB) in TRA-treated HER2+ breast cancer patients is conflicting. We hypothesized that concurrent use of RAAS inhibitors would prevent TRA-induced cardiotoxicity (TIC). Methods and materials Surveillance ejection fraction (EF) at 3-month intervals up to 36 months obtained from echocardiogram or multigated acquisition (MUGA) scans were retrospectively compared to baseline EF in TRA-treated HER2+ breast cancer patients between 2011 to 2016 at a tertiary cancer center. TIC was defined as a decrease of EF by more than 15 EF percentage points from baseline on surveillance imaging. Cardiac medications and comorbidities were compared between patients with reduced EF secondary to TIC (rEF) and patients who did not experience TIC (pEF). A published clinical risk score (CRS) was applied to the patient population with calculated sensitivity analyses to determine if the CRS could predict TIC. Results Of 127 patients with TRA-treated HER2+ breast cancer, 11% developed cardiotoxicity resulting in discontinuation of TRA. Cardiotoxicity with reduced EF was seen as early as 3 months and at subsequent 3-month follow up intervals up to the 15-month follow-up. Co-existing arrhythmia, coronary artery disease (CAD), hypertension (HTN) and diabetes mellitus (DM) tended to infer an increased risk for cardiotoxicity. Patients with pEF were found to be concurrently on a RAAS inhibitor more than the rEF group (OR of 0.24, 95% CI 0.05-1.11, p 0.06). The CRS high-risk cut-off had a sensitivity of 0.17 (95% CI 0.03-0.49), specificity of 0.89 (95% CI 0.82-0.94), positive predictive value of 0.14 (95% CI 0.03-0.44) and negative predictive value of 0.91 (95% CI 0.84-0.95). Conclusion Our data suggest that the concurrent use of a RAAS inhibitors during TRA treatment may provide a protective effect against TIC and warrants further investigation. The low sensitivity and positive predictive value demonstrated that the CRS has minimal utility as a screening tool for prediction of patients at high risk for TIC. Therefore, closer surveillance of patients receiving TRA is warranted for early detection of TIC.
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Affiliation(s)
- Melissa Y Y Moey
- 1Department of Internal Medicine, Vidant Medical Center/East Carolina University, 2100 Stantonsburg Road, Greenville, North Carolina 27834 USA
| | - Darla K Liles
- 1Department of Internal Medicine, Vidant Medical Center/East Carolina University, 2100 Stantonsburg Road, Greenville, North Carolina 27834 USA.,2Department of Hematology and Oncology, Vidant Medical Center/East Carolina University, 2100 Stantonsburg Road, Greenville, North Carolina 27834 USA
| | - Blase A Carabello
- 1Department of Internal Medicine, Vidant Medical Center/East Carolina University, 2100 Stantonsburg Road, Greenville, North Carolina 27834 USA.,3Department of Cardiology, Vidant Medical Center/East Carolina University, 2100 Stantonsburg Road, Greenville, North Carolina 27834 USA
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ZHANG Z, CHEN C, LV S, ZHU Y, FANG T. Comparing the Efficacy of Angiotensin Converting Enzyme Inhibitors with Calcium Channel Blockers on the Treatment of Diabetic Nephropathy: A Meta-Analysis. Iran J Public Health 2019; 48:189-197. [PMID: 31205872 PMCID: PMC6556194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The angiotensin-converting enzyme inhibitors (ACEIs) could improve the symptoms of diabetic nephropathy. Whether the calcium channel blockers (CCBs) could be as effective as ACEIs on treating diabetic nephropathy is controversial. Here, we aimed to compare the efficacy of ACEIs with CCBs on the treatment of diabetic nephropathy by performing a meta-analysis of randomized controlled trials (RCTs). METHODS The Pubmed, Medline, Embase and The Cochrane Database were searched up to July 2017 for eligible randomized clinical trials studies. Effect sizes were summarized as mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (P-value<0.05). RESULTS Seven RCTs involving 430 participants comparing ACEIs with CCBs were included. No benefit was seen in comparative group of ACEIs on systolic blood pressure (SBP) (MD=1.05 mmHg; 95% CI: -0.97 to 3.08, P=0.31), diastolic blood pressure (DBP) (MD= -0.34 mmHg; 95% CI: -1.2 to 0.51, P=0.43), urinary albumin excretion rates (UAER) (MD=1.91μg/min; 95% CI: -10.3 to 14.12, P=0.76), 24-h urine protein (24-UP) (SMD=-0.26; 95%CI: -0.55 to 0.03, P=0.08), glomerular filtration rate (GFR) (SMD=0.01; 95% CI: -0.38 to 0.41, P=0.95). On safety aspect, the risk of adverse reactions between ACEIs group and CCBs group are similar (RR=1.18; 95% CI: 0.61 to 2.28; P=0.61). CONCLUSION Both ACEIs and CCBs could improve the BP, UAER, 24h-UP, and GFR of diabetic nephropathy to a similar extent.
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Affiliation(s)
- Zhaowei ZHANG
- Department of Pharmacy, Jin Hua Municipal Central Hospital, Jin Hua 32100, China,Corresponding Author:
| | - Chunlin CHEN
- College of Chemistry and Bio-Engineering, Yi Chun University, Yi Chun 336000, China
| | - Shiwen LV
- Department of Pharmacy, Jin Hua Municipal Central Hospital, Jin Hua 32100, China
| | - Yalan ZHU
- Department of Pharmacy, Jin Hua Municipal Central Hospital, Jin Hua 32100, China
| | - Tianzi FANG
- Department of Pharmacy, Jin Hua Municipal Central Hospital, Jin Hua 32100, China
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Omboni S, Volpe M. Angiotensin Receptor Blockers Versus Angiotensin Converting Enzyme Inhibitors for the Treatment of Arterial Hypertension and the Role of Olmesartan. Adv Ther 2019; 36:278-297. [PMID: 30591990 PMCID: PMC6824372 DOI: 10.1007/s12325-018-0859-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 12/24/2022]
Abstract
Blood pressure lowering by all classes of antihypertensive drugs is accompanied by significant reductions of stroke and major cardiovascular (CV) events. Drugs acting on the renin–angiotensin–aldosterone system, such as angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), showed similar benefit on major CV events to other antihypertensive medications. In real-world practice, ARBs reduced by 10% the incidence of CV mortality, non-fatal myocardial infarction, non-fatal stroke and provided superior protection against CV events than ACEIs in high-risk patients. Despite similar antihypertensive properties and a favourable safety profile for both ACEIs and ARBs, evidence indicates that patients treated with ARBs have lower rates of withdrawal for adverse events and greater persistence to therapy than those treated with ACEIs. Among ARBs, olmesartan is one of the latest generation compounds introduced in clinical practice for treating hypertension: head-to-head comparative trials suggest that the efficacy of olmesartan is superior to that of commonly prescribed ACEIs (ramipril and perindopril). The drug, administered as a monotherapy or in combination with a dihydropyridine calcium channel blocker or a thiazide diuretic, has proved to be effective in maintaining blood pressure stability over 24 h, with a favourable safety profile and low discontinuation rates. These properties are pivotal for considering olmesartan as a useful antihypertensive agent especially for high-risk patients (e.g. elderly, diabetics, patients with metabolic syndrome). Funding: Article preparation and open access fee were funded by Menarini International Operations Luxembourg S.A. (M.I.O.L.)
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Herr AC, Biedermann T, Brockow K. [Allergic emergencies]. Hautarzt 2018; 69:352-363. [PMID: 29696352 DOI: 10.1007/s00105-018-4163-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Both anaphylactic reactions and angioedema in the head and neck area can be life-threatening and require emergency treatment. Therapy needed is primarily directed by the patient's symptoms. The first measures taken should consist of immediate disruption of the allergen contact, adequate positioning of the patient, the insertion of an intravenous catheter and an emergency call. In case of cardiovascular or respiratory involvement, intramuscular ± inhalative adrenalin is the treatment of choice. In case of cardiovascular involvement, volume substitution by intravenous catheter and oxygen administration are crucial and in lower airway obstruction, additionally short-acting beta mimetics should be inhaled. Intravenous H1-antihistamines and glucocorticoids are added. Allergic reaction confined to the skin and mucosal surfaces without respiratory involvement or to the gastrointestinal tract should also be treated with intravenous H1-antihistamines and glucocorticoids. Angioedema in the head and neck area can, however, also be associated with a life-threatening upper airway obstruction. Histamine-induced angioedema should be treated as anaphylaxis involving the upper respiratory tract. In hereditary angioedema, or in unclassified angioedema unresponsive to therapy, early airway maintenance and subcutaneous injection of bradykinin-receptor antagonist icatibant, intravenous injection of C1-inhibitor concentrate or fresh frozen plasma is recommended. The same approach should be taken for severe angiotensin converting enzyme inhibitor-induced angioedema with dyspnea. Intubation by skilled personal is indicated in inspiratory stridor and dyspnea at rest. In all cases of anaphylaxis or angioemdema, patients should be surveyed until a safe remission is achieved.
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Affiliation(s)
- A-C Herr
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Str. 29, 80802, München, Deutschland
| | - T Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Str. 29, 80802, München, Deutschland
| | - K Brockow
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Str. 29, 80802, München, Deutschland.
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Atey TM, Teklay T, Asgedom SW, Mezgebe HB, Teklay G, Kahssay M. Treatment optimization of angiotensin converting enzyme inhibitors and associated factors in Ayder Comprehensive Specialized Hospital: a cross-sectional study. BMC Res Notes 2018; 11:209. [PMID: 29592815 PMCID: PMC5875017 DOI: 10.1186/s13104-017-2820-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/26/2016] [Accepted: 09/30/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitors have morbidity and mortality benefits in heart failure. Failure to optimize treatment using these medications increases hospitalizations, worsens signs and symptoms of heart failure, and reduces the overall treatment outcome. Therefore, the main purpose of this study was to assess the practice of treatment optimization of these medications and associated factors. RESULTS A hospital-based cross-sectional study was conducted on 61 ambulatory heart failure patients, recruited using a convenience sampling technique, from February 25 to May 24, 2016 at the cardiology clinic of Ayder Comprehensive Specialized Hospital. Descriptive, inferential and Kaplan-Meier 'tolerability' analyses were employed. All patients were taking only enalapril as part of their angiotensin converting enzyme inhibitor treatment. According to the 2013 American College of Cardiology/American Heart Association guideline, about fourth-fifth (80.3%) of the patients were tolerating to the hypotensive effect of enalapril. The dose of enalapril was timely titrated (every 2-4 weeks) and was optimized for only 11.5 and 27.8% of the patients, respectively. Considering the tolerance, timely titration, and dose optimization, only 3.3% of the overall enalapril treatment was optimized. Multivariate regression results showed that the odds of having timely titration of enalapril for patients who were taking enalapril and calcium channel blockers were almost 20 times [adjusted odds ratio (AOR) = 21.68, 95% confidence interval (CI) 1.23-383.16, p < 0.036] more compared to patients who were taking enalapril and β-blockers. A Log Rank Chi Square result showed a 19.42 magnitude of better toleration of enalapril (p < 0.001) for patients who were taking enalapril for more than 1 year compared to less than a year. CONCLUSION This study provides a platform for assessment of the treatment optimization practice of enalapril, which remains the pressing priority and found to be poor in the ambulatory setting, despite a better tolerability to the hypotensive effect of enalapril. We call for greater momentum of efforts by health care providers in optimizing the treatment practice to benchmark with other optimization practices.
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Affiliation(s)
- Tesfay Mehari Atey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray Ethiopia
| | - Tsegay Teklay
- School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray Ethiopia
| | - Solomon Weldegebreal Asgedom
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray Ethiopia
| | - Haftay Berhane Mezgebe
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray Ethiopia
| | - Gebrehiwot Teklay
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray Ethiopia
| | - Molla Kahssay
- School of Public Health, College of Health Sciences, Semera University, Semera, Afar Ethiopia
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Dargad RR, Prajapati MR, Dargad RR, Parekh JD. Sacubitril/valsartan: A novel angiotensin receptor-neprilysin inhibitor. Indian Heart J 2018; 70 Suppl 1:S102-10. [PMID: 30122239 DOI: 10.1016/j.ihj.2018.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 07/18/2017] [Accepted: 01/08/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To describe the efficacy, superiority and safety profile of the first-in-class angiotensin receptor-neprilysin inhibitor "Sacubitril/Valsartan" as compared to angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blocker (ARB) in heart failure (HF) patients, reviewing data available from both clinical and pre-clinical studies. Evidences on health care utilization outcomes such as hospitalizations and emergency department visits were also evaluated. MATERIAL (DATA SOURCE) Sources: Medical literature on 'Sacubitril/Valsartan' and 'Angiotensin Receptor-Neprilysin Inhibitor' was identified by searching databases (including, but not limited to, PubMed, Embase and HighWire) for articles published since 1991, bibliographies from published literature, clinical trial registries/databases and websites (including those of regional regulatory agencies and the manufacturer). Additional information (including contributory unpublished data) was also requested from the companies developing the drug. SEARCH STRATEGY We conducted separate searches for each of the interventions of interest. The timeframe for both searches spanned the period from January 1991 to the most recently published data available and focused on PubMed, Embase and HighWire indexed articles. The search strategies included a combination of indexing terms as well as free-text terms included separately in 'Keywords' section. To supplement the above searches and ensure optimal and complete literature retrieval, we performed a manual check of the references of recent relevant reviews and meta-analysis. Searches were last updated on 12th July 2017. SELECTION Studies in patients with hypertension who received sacubitril/valsartan combination drug were included. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well-controlled trials with appropriate statistical methodology was preferred. Relevant pharmacodynamics and pharmacokinetics data was also included. DATA EVALUATION Many clinical trials have been conducted comparing the efficacy of sacubitril/valsartan with other anti-hypertensives. The trials have shown sacubitril/valsartan to be more effective in improving symptoms and physical limitations, reducing the risk of cardiovascular (CV) death, HF hospitalization, and the overall mortality and morbidity compared to its counterparts. CONCLUSION Effective reduction of blood pressure to accepted goals is the key to reduce the risk of CV events and stroke. Dual inhibition of neprilysin and the angiotensin receptor with sacubitril/valsartan may represent an attractive and serendipitous therapeutic approach for a range of CV diseases, including hypertension and HF, in which vasoconstriction, volume overload and neuro-hormonal activation play a part in pathophysiology. Sacubitril/Valsartan appears to be more efficacious in reducing blood pressure than currently available ACEi and ARBs with a similar safety and tolerability profile. Besides, pleiotropic benefits like HbA1c reduction, better eGFR progression and a greater decrease in blood pressure and serum creatinine levels make this drug a novel addition to the current hypertension armamentarium.
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Bessaguet F, Danigo A, Magy L, Sturtz F, Desmoulière A, Demiot C. Candesartan prevents resiniferatoxin-induced sensory small-fiber neuropathy in mice by promoting angiotensin II-mediated AT2 receptor stimulation. Neuropharmacology 2017; 126:142-150. [PMID: 28882562 DOI: 10.1016/j.neuropharm.2017.08.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 05/24/2017] [Revised: 07/04/2017] [Accepted: 08/31/2017] [Indexed: 12/27/2022]
Abstract
Sensory defects associated with small-fiber neuropathy (SFN) can lead to profound disabilities. The relationship between the sensory nervous system and modulation of the renin-angiotensin system (RAS) has been described and focused on pain and neurodegeneration in several animal models. We have recently developed an experimental model of functional sensory neuropathy showing thermal hypoalgesia and neuropeptide depletion without nerve fiber degeneration. Here, we aimed to determine whether the modulation of angiotensin II (Ang II) activity could prevent sensory neuropathy induced by RTX. Control and RTX mice received ramipril, an Ang II converting enzyme (ACE) inhibitor, (0.5 mg/kg/day) or candesartan, an Ang II type 1 receptor (AT1R) blocker (0.5 mg/kg/day), one day before vehicle or RTX administration, and each day for the next seven days. Ramipril did not have a beneficial effect in RTX mice, whereas candesartan prevented thermal hypoalgesia and reduced neuropeptide depletion in intraepidermal nerve fibers and dorsal root ganglion neurons. The preventive effect of candesartan was not observed in mice deficient for the Ang II type 2 receptor (AT2R) and was counteracted in wild type mice by EMA200, an AT2R antagonist (3 mg/kg/day). Thus, candesartan may promote AT2R activation by blocking AT1R and increasing Ang II production and enhance its mechanisms of neuroprotection in our RTX model. Our finding that candesartan prevents nociception deficits and neuropeptide depletion encourages the evaluation of its therapeutic potential in patients presenting SFN, particularly those who experience chemotherapy-induced SFN.
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Affiliation(s)
- Flavien Bessaguet
- EA 6309 - Myelin Maintenance & Peripheral Neuropathy, Faculties of Medicine and Pharmacy, University of Limoges, Limoges, France
| | - Aurore Danigo
- EA 6309 - Myelin Maintenance & Peripheral Neuropathy, Faculties of Medicine and Pharmacy, University of Limoges, Limoges, France
| | - Laurent Magy
- Department of Neurology, Reference Center for Rare Peripheral Neuropathies, University Hospital of Limoges, Limoges, France
| | - Franck Sturtz
- EA 6309 - Myelin Maintenance & Peripheral Neuropathy, Faculties of Medicine and Pharmacy, University of Limoges, Limoges, France
| | - Alexis Desmoulière
- EA 6309 - Myelin Maintenance & Peripheral Neuropathy, Faculties of Medicine and Pharmacy, University of Limoges, Limoges, France
| | - Claire Demiot
- EA 6309 - Myelin Maintenance & Peripheral Neuropathy, Faculties of Medicine and Pharmacy, University of Limoges, Limoges, France.
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Vassallo MC, Tartamella F, Testa F. Should we withhold angiotensin converting enzyme inhibitors before anaesthesia? An updated debate on the pros and cons. J Clin Anesth 2017; 42:51-2. [PMID: 28821004 DOI: 10.1016/j.jclinane.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 07/09/2017] [Accepted: 07/15/2017] [Indexed: 11/21/2022]
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Ribeiro SC, Figueiredo AE, Barretti P, Pecoits-Filho R, de Moraes TP. Impact of Renin-Angiotensin Aldosterone System Inhibition on Serum Potassium Levels among Peritoneal Dialysis Patients. Am J Nephrol 2017; 46:150-155. [PMID: 28738355 DOI: 10.1159/000479011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/15/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The chronic use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blocker has been associated with hyperkalemia in patients with reduced renal function even after the initiation of hemodialysis. Whether such medications may cause a similar effect in peritoneal dialysis patients is not well established. So, the aim of our study was to analyze the impact of renin-angiotensin-aldosterone inhibitors on the serum levels of potassium in a national cohort of peritoneal dialysis patients. METHOD A prospective, observational, nationwide cohort study was conducted. We identified all incident patients on peritoneal dialysis that had angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) prescribed for at least 3 months and a similar period of time without these medications. Patients were divided into 4 groups: Groups I and III correspond to patients using, respectively, an ACEi or ARB and then got the drug suspended; Groups II and IV started peritoneal dialysis without the use of any renin-angiotensin aldosterone system inhibitor and then got, respectively, an ACEi or ARB introduced. Changes in potassium serum levels were compared using 2 statistical approaches: (1) the non-parametric Wilcoxon test for repeated measures and (2) a crossover analysis. RESULTS Mean potassium serum levels at the first phase of the study for Groups I, II, III, and IV were, respectively, 4.46 ± 0.79, 4.33 ± 0.78, 4.41 ± 0.63, and 4.44 ± 0.56. Changes in mean potassium serum levels for Groups I, II, III, and IV were -0.10 ± 0.60, 0.02 ± 0.56, -0.06 ± 0.46, and 0.03 ± 0.50, respectively. CONCLUSION The use of ACEi and ARB was not associated with a greater risk for hyperkalemia in stable peritoneal dialysis patients independently of residual renal function.
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Heras Benito M, Fernández-Reyes MJ, Guerrero Díaz MT, Muñoz Pascual A. [Serum potassium levels and long-term mortality in the elderly with hypertension]. Hipertens Riesgo Vasc 2017; 34:115-119. [PMID: 28344049 DOI: 10.1016/j.hipert.2017.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/30/2016] [Revised: 01/05/2017] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
Abstract
There is increasing evidence that small variations within the normal range (3.5-5mEq/L) of potassium are associated with mortality. OBJECTIVE To determine whether there is an association between serum potassium level (sK) and mortality in a cohort of elderly hypertensive patients. PATIENTS AND METHODS A retrospective, observational study was conducted on patients who had sK levels available in a period of clinical stability during their recruitment between January and April 2006 and followed-up for 10 years. The study obtained a total of 62 stable patients, with a mean age of 82.19±6 years (range 69-97), with 74.2% women, 33.9% diabetics, 20.3% with a history of heart failure, Ischaemic heart disease was observed in 19.4% and 44.3% received Angiotensin Converting Enzyme (ACE) inhibitors. An analysis was performed on the mortality rate during the 10 year period. The statistics were performed using the SPSS15.0 package. RESULTS There were 49 deaths. The sK had a normal distribution. Baseline mean sK levels and median were 4.45±0.5mEq/L (range 3.1-5.5 mEq/L). Baseline sK levels were significantly higher in diabetic patients and patients on ACE inhibitors. The patients that died had higher sK levels (4.53±0.49mEq/L versus 4.14±0.40mEq/L, P=.011). Survival estimated using Kaplan Meier showed that patients with sK levels higher than the median and P75 had higher mortality. CONCLUSIONS In our study, sK levels greater than 4.45mEq/L were associated with mortality. When selecting antihypertensive treatment in hypertensive elderly patients,, the use of ACE inhibitors should be assessed individually, with close monitoring at sK levels and try to keep them in the lower limit of the normal range (<4.45 mEq/L).
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Affiliation(s)
- M Heras Benito
- Servicio de Nefrología, Hospital General de Segovia, Segovia, España.
| | | | | | - A Muñoz Pascual
- Servicio de Geriatría, Hospital General de Segovia, Segovia, España
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Baptista LC, Machado-Rodrigues AM, Veríssimo MT, Martins RA. Exercise training improves functional status in hypertensive older adults under angiotensin converting enzymes inhibitors medication. Exp Gerontol 2017. [PMID: 28645696 DOI: 10.1016/j.exger.2017.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The study aims to analyze the effect of three types of treatment on functional status, and cardiovascular risk outcomes in hypertensive older adults with comorbidities. METHODS Participants (n=418) underwent one of the following 3 conditions: i) multicomponent exercise training 3 times/week (MEX; n=116); ii) angiotensin converting enzyme inhibitors used mono-dose daily (ACEi; n=70); iii) combined exercise and ACEi drugs (ACEiMEX; n=232). The trial was completed by 82% of the participants (n=342): MEX (n=90); ACEi (n=66); ACEiMEX (n=186). Baseline and 2-year follow-up evaluations included the Senior Fitness Test battery, Short Form Health Survey 36 (SF-36), the health history questionnaires, anthropometric and hemodynamic profile. RESULTS MEX and ACEiMEX groups improved all physical functional status outcomes, decreased systolic (SBP) and diastolic blood pressure (p<0.001) and augmented the physical functioning, role physical and physical component score (PCS) (p<0.05), but also bodily pain (p<0.05). The ACEi group reduced the upper body strength, upper and lower body flexibility and aerobic endurance (p<0.05); worsened the anthropometric profile, and SBP (p<0.001); and decreased general health and PCS (p<0.05). CONCLUSIONS The improvement of the physical functioning and HRQoL in older hypertensive adults using ACEi medications only occur if they adopt an exercise training regimen, increasing also the management of the blood pressure and other cardiovascular risk factors.
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Affiliation(s)
| | | | | | - Raul A Martins
- Estádio Universitário de Coimbra, Pavilhão 3, 3000 Coimbra, Portugal.
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Shen JI, Saxena AB, Vangala S, Dhaliwal SK, Winkelmayer WC. Renin-angiotensin system blockers and residual kidney function loss in patients initiating peritoneal dialysis: an observational cohort study. BMC Nephrol 2017. [PMID: 28623899 PMCID: PMC5473971 DOI: 10.1186/s12882-017-0616-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 12/03/2022] Open
Abstract
Background Although angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-II receptor blockers (ARB) have been shown to preserve residual kidney function in a select group of Asian patients undergoing continuous ambulatory peritoneal dialysis (PD) in two small randomized clinical trials, the effectiveness of these drugs has yet to be demonstrated in a more diverse population of patients with multiple comorbid conditions. We investigated the association between ACEI/ARB use and development of recorded anuria in a cohort of patients initiating PD in the U.S. Methods We conducted a retrospective observational cohort study using the US Renal Data System and electronic health records data from a large national dialysis provider. We identified adult patients who initiated PD from 2007 to 2011. Only patients who participated in the federal prescription drug benefit program, Medicare Part D, for the first 90 days of dialysis were included. Patients who filled a prescription for an ACEI or ARB during those 90 days were considered users. We applied Cox proportional hazards models to an inverse probability of treatment-weighted (IPTW) cohort to estimate the hazard ratio (HR) for anuria (24-h urine volume < 200 ml) in ACEI/ARB users vs. non-users. Results Among 886 patients, 389 (44%) used an ACEI/ARB. Almost a third of these patients were black or Hispanic, and more than a quarter had comorbidities that would have excluded them from the randomized clinical trials of ACEI/ARB. Two hundred eighty patients reached anuria over 840 person-years of follow-up, for a composite event rate of 33 events per 100 person-years. We found no clear association between ACEI/ARB use and progression to anuria [HR: 0.86, 95% CI: 0.73–1.02]. Conclusions ACEI/ARB use is common in patients initiating PD in the U.S. but was not associated with a lower risk of anuria. Residual confounding by unmeasured variables is an important limitation of this observational study. Still, these findings suggest that pragmatic clinical trials are warranted to test the effectiveness of ACEI/ARB in slowing the decline of residual kidney function in a diverse population of peritoneal dialysis patients with multiple comorbid conditions. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0616-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jenny I Shen
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson St., C-1 Annex, Torrance, CA, 90502, USA. .,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Anjali B Saxena
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Satvinder K Dhaliwal
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Wolfgang C Winkelmayer
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Ferrario CM, Mullick AE. Renin angiotensin aldosterone inhibition in the treatment of cardiovascular disease. Pharmacol Res 2017; 125:57-71. [PMID: 28571891 DOI: 10.1016/j.phrs.2017.05.020] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 02/07/2023]
Abstract
A collective century of discoveries establishes the importance of the renin angiotensin aldosterone system in maintaining blood pressure, fluid volume and electrolyte homeostasis via autocrine, paracrine and endocrine signaling. While research continues to yield new functions of angiotensin II and angiotensin-(1-7), the gap between basic research and clinical application of these new findings is widening. As data accumulates on the efficacy of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers as drugs of fundamental importance in the treatment of cardiovascular and renal disorders, it is becoming apparent that the achieved clinical benefits is suboptimal and surprisingly no different than what can be achieved with other therapeutic interventions. We discuss this issue and summarize new pathways and mechanisms effecting the synthesis and actions of angiotensin II. The presence of renin-independent non-canonical pathways for angiotensin II production are largely unaffected by agents inhibiting renin angiotensin system activity. Hence, new efforts should be directed to develop drugs that can effectively block the synthesis and/or action of intracellular angiotensin II. Improved drug penetration into cardiac or renal sites of disease, inhibiting chymase the primary angiotensin II forming enzyme in the human heart, and/or inhibiting angiotensinogen synthesis would all be more effective strategies to inhibit the system. Additionally, given the role of angiotensin II in the maintenance of renal homeostatic mechanisms, any new inhibitor should possess greater selectivity of targeting pathogenic angiotensin II signaling processes and thereby limit inappropriate inhibition.
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Affiliation(s)
- Carlos M Ferrario
- Department of Surgery, Wake Forest University Health Science, Medical Center Blvd., Winston Salem, NC 27157, United States.
| | - Adam E Mullick
- Cardiovascular Antisense Drug Discovery, Ionis Pharmaceuticals, Inc., Carlsbad, CA 92010, United States
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Omboni S, Malacco E, Napoli C, Modesti PA, Manolis A, Parati G, Agabiti-Rosei E, Borghi C. Efficacy of Zofenopril vs. Irbesartan in Combination with a Thiazide Diuretic in Hypertensive Patients with Multiple Risk Factors not Controlled by a Previous Monotherapy: A Review of the Double-Blind, Randomized "Z" Studies. Adv Ther 2017; 34:784-798. [PMID: 28260186 PMCID: PMC5406448 DOI: 10.1007/s12325-017-0497-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Indexed: 11/25/2022]
Abstract
Combinations between an angiotensin converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB) and hydrochlorothiazide (HCTZ) are among the recommended treatments for hypertensive patients uncontrolled by monotherapy. Four randomized, double-blind, parallel group studies with a similar design, including 1469 hypertensive patients uncontrolled by a previous monotherapy and with ≥1 cardiovascular risk factor, compared the efficacy of a combination of a sulfhydryl ACE inhibitor (zofenopril at 30 or 60 mg) or an ARB (irbesartan at 150 or 300 mg) plus HCTZ 12.5 mg. The extent of blood pressure (BP)-lowering was assessed in the office and over 24 h. Pleiotropic features of the treatments were evaluated by studying their effect on systemic inflammation, organ damage, arterial stiffness, and metabolic biochemical parameters. Both treatments similarly reduced office and ambulatory BPs after 18-24 weeks. In the ZODIAC study a larger reduction in high sensitivity C reactive protein (hs-CRP) was observed under zofenopril (-0.52 vs. +0.97 mg/dL under irbesartan, p = 0.001), suggesting a potential protective effect against the development of atherosclerosis. In the ZENITH study the rate of carotid plaque regression was significantly larger under zofenopril (32% vs. 16%; p = 0.047). In the diabetic patients of the ZAMES study, no adverse effects of treatments on blood glucose and lipids as well as an improvement of renal function were observed. In patients with isolated systolic hypertension of the ZEUS study, a slight and similar improvement in renal function and small reductions in pulse wave velocity (PWV), augmentation index (AI), and central systolic BP were documented with both treatments. Thus, the fixed combination of zofenopril and HCTZ may have a relevant place in the treatment of high-risk or monotherapy-treated uncontrolled hypertensive patients requiring a more prompt, intensive, and sustained BP reduction, in line with the recommendations of current guidelines.
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Affiliation(s)
- Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy.
| | | | - Claudio Napoli
- Department of Internal Medicine and Specialistic Units, U.O.C. of Clinical Immunology, Immunohematology, Transfusion Medicine and Organ Transplantation, Azienda Ospedaliera Universitaria (AOU), Second University of Naples, Naples, Italy
- SDN Foundation and IRCCS, Naples, Italy
| | - Pietro Amedeo Modesti
- Department of Clinical and Experimental Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Athanasios Manolis
- Asklepeion General Hospital of Voula, University of Athens, Athens, Greece
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Enrico Agabiti-Rosei
- Division of Medicine and Surgery, Spedali Civili and University of Brescia, Brescia, Italy
| | - Claudio Borghi
- Department of Internal Medicine, University of Bologna, Bologna, Italy
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Abstract
Hyperkalemia can be a life-threatening disorder, especially for at-risk patients with heart failure, chronic kidney disease, with diabetes, and patients on certain drugs like renin-angiotensin-aldosterone system antagonists and mineralocorticoid receptor antagonists. There are limited therapeutic options available for hyperkalemia, and they have narrow effectiveness because of their unfavorable side effects profile in long-term and high cost utilization requiring inpatient care. Patiromersorbitex calcium and sodium zirconium cyclosilicate are novel potassium-lowering compounds for the treatment and prevention of hyperkalemia in at-risk population. These therapeutic agents have shown encouraging results in early phase II and phase III clinical trials. However, there is need to further study their efficacy and safety in heart failure population in order to establish their clinical use. The focus of this chapter will be to promote better understanding of potassium homeostasis in heart failure patients and the mechanistic overview of novel drugs, with emphasis on heart failure population.
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Affiliation(s)
| | - Aditi A Bhagat
- Cardiology Division, Stony Brook University, Stony Brook, NY, USA
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Javed Butler
- Cardiology Division, Stony Brook University, Stony Brook, NY, USA.
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