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Zhou Z, Orchard SG, Nelson MR, Fravel MA, Ernst ME. Angiotensin Receptor Blockers and Cognition: a Scoping Review. Curr Hypertens Rep 2024; 26:1-19. [PMID: 37733162 PMCID: PMC10796582 DOI: 10.1007/s11906-023-01266-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of the association between angiotensin II receptor blocker (ARB) use and cognitive outcomes. RECENT FINDINGS ARBs have previously shown greater neuroprotection compared to other anti-hypertensive classes. The benefits are primarily attributed to the ARB's effect on modulating the renin-angiotensin system via inhibiting the Ang II/AT1R pathway and activating the Ang II/AT2R, Ang IV/AT4R, and Ang-(1-7)/MasR pathways. These interactions are associated with pleiotropic neurocognitive benefits, including reduced β-amyloid accumulation and abnormal hyperphosphorylation of tau, ameliorated brain hypo-fusion, reduced neuroinflammation and synaptic dysfunction, better neurotoxin clearing, and blood-brain barrier function restoration. While ACEis also inhibit AT1R, they simultaneously lower Ang II and block the Ang II/AT2R and Ang IV/AT4R pathways that counterbalance the potential benefits. ARBs may be considered an adjunctive approach for neuroprotection. This preliminary evidence, coupled with their underlying mechanistic pathways, emphasizes the need for future long-term randomized trials to yield more definitive results.
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Affiliation(s)
- Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Michelle A Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IA, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IA, USA.
- Department of Family Medicine, Carver College of Medicine, 01291-A PFP, The University of Iowa, 200 Hawkins Dr, Iowa, IA, 52242, USA.
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Lyon M, Fullerton JL, Kennedy S, Work LM. Hypertension & dementia: Pathophysiology & potential utility of antihypertensives in reducing disease burden. Pharmacol Ther 2024; 253:108575. [PMID: 38052309 DOI: 10.1016/j.pharmthera.2023.108575] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/07/2023]
Abstract
Dementia is a common cause of disability and dependency among the elderly due to its progressive neurodegenerative nature. As there is currently no curative therapy, it is of major importance to identify new ways to reduce its prevalence. Hypertension is recognised as a modifiable risk factor for dementia, particularly for the two most common subtypes; vascular dementia (VaD) and Alzheimer's disease (AD). From the current literature, identified through a comprehensive literature search of PubMed and Cochrane Library, this review aims to establish the stage in adulthood when hypertension becomes a risk for cognitive decline and dementia, and whether antihypertensive treatment is effective as a preventative therapy. Observational studies generally found hypertension in mid-life (age 45-64) to be correlated with an increased risk of cognitive decline and dementia incidence, including both VaD and AD. Hypertension manifesting in late life (age ≥ 65) was demonstrated to be less of a risk, to the extent that incidences of high blood pressure (BP) in the very elderly (age ≥ 75) may even be related to reduced incidence of dementias. Despite the evidence linking hypertension to dementia, there were conflicting findings as to whether the use of antihypertensives was beneficial for its prevention and this conflicting evidence and inconsistent results could be due to the methodological differences between the reviewed observational and randomised controlled trials. Furthermore, dihydropyridine calcium channel blockers and potassium-sparing diuretics were proposed to have neuroprotective properties in addition to BP lowering. Overall, if antihypertensives are confirmed to be beneficial by larger-scale homogenous trials with longer follow-up durations, treatment of hypertension, particularly in mid-life, could be an effective strategy to considerably lower the prevalence of dementia. Furthermore, greater clarification of the neuroprotective properties that some antihypertensives possess will allow for better clinical practice guidance on the choice of antihypertensive class for both BP lowering and dementia prevention.
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Affiliation(s)
- Mara Lyon
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - Josie L Fullerton
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - Simon Kennedy
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - Lorraine M Work
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, UK.
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Canoy D, Nazarzadeh M, Copland E, Bidel Z, Rao S, Li Y, Rahimi K. How Much Lowering of Blood Pressure Is Required to Prevent Cardiovascular Disease in Patients With and Without Previous Cardiovascular Disease? Curr Cardiol Rep 2022; 24:851-860. [PMID: 35524880 PMCID: PMC9288358 DOI: 10.1007/s11886-022-01706-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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] [Accepted: 04/19/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE OF REVIEW To review the recent large-scale randomised evidence on pharmacologic reduction in blood pressure for the primary and secondary prevention of cardiovascular disease. RECENT FINDINGS Based on findings of the meta-analysis of individual participant-level data from 48 randomised clinical trials and involving 344,716 participants with mean age of 65 years, the relative reduction in the risk of developing major cardiovascular events was proportional to the magnitude of achieved reduction in blood pressure. For each 5-mmHg reduction in systolic blood pressure, the risk of developing cardiovascular events fell by 10% (hazard ratio [HR] (95% confidence interval [CI], 0.90 [0.88 to 0.92]). When participants were stratified by their history of cardiovascular disease, the HRs (95% CI) in those with and without previous cardiovascular disease were 0.89 (0.86 to 0.92) and 0.91 (0.89 to 0.94), respectively, with no significant heterogeneity in these effects (adjusted P for interaction = 1.0). When these patient groups were further stratified by their baseline systolic blood pressure in increments of 10 mmHg from < 120 to ≥ 170 mmHg, there was no significant heterogeneity in the relative risk reduction across these categories in people with or without previous cardiovascular disease (adjusted P for interaction were 1.00 and 0.28, respectively). Pharmacologic lowering of blood pressure was effective in preventing major cardiovascular disease events both in people with or without previous cardiovascular disease, which was not modified by their baseline blood pressure level. Treatment effects were shown to be proportional to the intensity of blood pressure reduction, but even modest blood pressure reduction, on average, can lead to meaningful gains in the prevention of incident or recurrent cardiovascular disease.
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Affiliation(s)
- Dexter Canoy
- Deep Medicine, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Hayes House 1F, 75 George St, Oxford, OX1 2BQ UK
- National Institutes of Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Milad Nazarzadeh
- Deep Medicine, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Hayes House 1F, 75 George St, Oxford, OX1 2BQ UK
| | - Emma Copland
- Deep Medicine, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Hayes House 1F, 75 George St, Oxford, OX1 2BQ UK
- National Institutes of Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Zeinab Bidel
- Deep Medicine, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Hayes House 1F, 75 George St, Oxford, OX1 2BQ UK
- National Institutes of Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Shihir Rao
- Deep Medicine, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Hayes House 1F, 75 George St, Oxford, OX1 2BQ UK
| | - Yikuan Li
- Deep Medicine, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Hayes House 1F, 75 George St, Oxford, OX1 2BQ UK
| | - Kazem Rahimi
- Deep Medicine, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Hayes House 1F, 75 George St, Oxford, OX1 2BQ UK
- National Institutes of Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Helou A, Stewart K, George J. Adherence to anti-hypertensive medication in pregnancy. Pregnancy Hypertens 2021; 25:230-234. [PMID: 34273672 DOI: 10.1016/j.preghy.2021.06.002] [Citation(s) in RCA: 1] [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: 09/06/2020] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess adherence to anti-hypertensive medication by pregnant women and to identify the factors associated with adherence or lack thereof. STUDY DESIGN Observational study in 100 pregnant women with either chronic hypertension or gestational hypertension who were being treated with at least one anti-hypertensive medication and attending antenatal clinics at one of two maternity hospitals. In-depth interviews were conducted with a subset of 27 women from the same group. Quotes from interview transcripts were used to illustrate the quantitative results. MAIN OUTCOME MEASURES BP control, self-reported adherence, complexity of medication regimen. RESULTS Participants (mean age 33 [±4.9] years; mean gestation 29 (±7) weeks) had a median blood pressure (BP) of 130/80 mmHg (IQR: 16/15). Sixty-five women had chronic hypertension, of whom 13 were diagnosed during pregnancy, before 20 weeks gestation. Thirty-five women had gestational hypertension. Ninety-two per cent of participants had sub-optimal adherence. There were no significant differences in adherence scores between participants with chronic hypertension and their counterparts. The main contributors to sub-optimal adherence were intentionally putting up with medical problems before taking any action, confusion about the medication, and making changes to the recommended medication regimen to suit lifestyle. CONCLUSIONS Nine out of ten pregnant women using anti-hypertensives self-reported some degree of suboptimal adherence, intentionally and/or unintentionally. Health professionals, including pharmacists, general practitioners and obstetricians, have a role in promoting optimal medication adherence.
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Affiliation(s)
- Amyna Helou
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
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Sarcan ET, Tas A, Silindir-Gunay M, Ozer AY, Palaska E, Hekimoglu B. Effect of X-Ray Irradiation on Some Analgesics, Anti-Diabetics, PPI'S, Anti-Hypertensives, Heart Failure Drugs in Tablet and Capsule Forms. J Pharm Sci 2020; 109:3653-3659. [PMID: 32976898 DOI: 10.1016/j.xphs.2020.09.028] [Citation(s) in RCA: 1] [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: 07/20/2020] [Revised: 09/02/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
X-ray is an ionizing-radiation and it has been used in many processes due to the developing technology. For security purposes, X-ray instruments are been using at the entrance of the airports, shopping centers, etc. In this study, potential effects of X-ray were investigated on five different types of drugs: analgesics (acetaminophen, acetylsalicylic acid, naproxen, flurbiprofen), proton pump inhibitors (lansoprazole, pantoprazole sodium sesquihydrate), anti-diabetics (metformin HCl, pioglitazone), heart failure drugs (verapamil HCl, spironolactone) and anti-hypertensives (losartan, clopidogrel hydrogen sulphate) by several different methods. In our previous study these drugs were analyzed by ESR before and after X-ray irradiation (0,24; 1,2; 58 mGy). According to the ESR results, acetylsalicylic acid tablets were affected after 58 mGy irradiation due to coated polymer (HPMC). In conclusion, these drugs were investigated before and after 0,24; 1,2 and 58 mGy X-ray irradiation by UV-spectrophotometry, dissolution test, SEM, FT-IR, DSC/TGA in this article. As a result of this study, X-ray did not cause a significant effect on drugs generally. Only a few significant differences were detected by different studies (for metformin HCl by DSC/TGA, for acetylsalicylic acid by dissolution test, and for acetaminophen and acetylsalicylic acid by UV spectrophotometry were detected significantly difference before and after irradiation).
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Affiliation(s)
- Elif Tugce Sarcan
- Radiopharmacy Department, Faculty of Pharmacy, Hacettepe University, 06100, Ankara, Turkey
| | - Asuman Tas
- Radiopharmacy Department, Faculty of Pharmacy, Hacettepe University, 06100, Ankara, Turkey
| | - Mine Silindir-Gunay
- Radiopharmacy Department, Faculty of Pharmacy, Hacettepe University, 06100, Ankara, Turkey
| | - Asuman Yekta Ozer
- Radiopharmacy Department, Faculty of Pharmacy, Hacettepe University, 06100, Ankara, Turkey.
| | - Erhan Palaska
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Hacettepe University, 06100, Ankara, Turkey
| | - Baki Hekimoglu
- Radiology Department, Diskapi Yildirim Beyazit Education and Research Hospital, Health Sciences University, 06110, Ankara, Turkey
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Abstract
Objectives: To evaluate the cost-effectiveness of olmesartan/amlodipine fixed-dose combination vs olmesartan and amlodipine free combination, amlodipine single drug, and valsartan/amlodipine fixed-dose combination in the treatment of hypertensive patients from payer perspective in China.Methods: A Markov model was constructed, which included five health states of hypertensive patients who are aged 35-84 years at baseline and free of cardiovascular disease. Clinical data were obtained from a network meta-analysis. Epidemiology data, adverse events (AEs), cost, and utility data were obtained from the literature. The cost associated with AEs was estimated based on the cost of same symptoms of hypertensive patients in an electric medical record database. The model projected quality-adjusted life years (QALYs) gained, total costs per patient in a 20-year time horizon, and incremental cost-effectiveness ratios. Probability sensitivity analyses (PSA) and one-way sensitivity analyses were conducted for the main parameters to test the robustness of the model.Results: Compared to olmesartan and amlodipine free combination, amlodipine, and valsartan/amlodipine fixed-dose combination, treatment with olmesartan/amlodipine fixed-dose combination led to fewer CVD events and deaths; resulted in an incremental cost of ¥-5,439 ($-791.36), ¥6,530 ($950.09), and ¥-1,019 ($-148.26) and gained additional QALYs of 0.052, 0.094, and 0.037 per patient, respectively. Compared with olmesartan and amlodipine free combination and valsartan/amlodipine fixed-dose combination, olmesartan/amlodipine fixed-dose combination was dominant. Compared with amlodipine alone, the incremental cost-effectiveness ratios were below the WHO recommended cost-effectiveness threshold, indicating the olmesartan/amlodipine fixed-dose combination was a cost-effective option for hypertensive patients in China. The 10-years' time horizon scenario analysis showed similar results to the 20-years' time horizon. Probabilistic sensitivity analysis and one-way sensitivity analyses showed the robustness of the model results.Conclusions: Olmesartan/amlodipine fixed-dose combination confers better health outcomes and costs less compared with olmesartan and amlodipine free combination and valsartan/amlodipine fixed-dose combination, and is cost-effective compared to amlodipine for hypertension treatment in China.
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Affiliation(s)
- Maodong Ren
- Shanghai Centennial Scientific Co., Ltd, Shanghai, China
| | - Dennis Xuan
- Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Yongji Lu
- Shanghai Centennial Scientific Co., Ltd, Shanghai, China
| | - YuYan Fu
- Health Economic Research Institute, Sun Yat-Sen University, Guangzhou, China
| | - Jianwei Xuan
- Health Economic Research Institute, Sun Yat-Sen University, Guangzhou, China
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Kaczmarski KR, Sozio SM, Chen J, Sang Y, Shafi T. Resistant hypertension and cardiovascular disease mortality in the US: results from the National Health and Nutrition Examination Survey (NHANES). BMC Nephrol 2019; 20:138. [PMID: 31023262 PMCID: PMC6485047 DOI: 10.1186/s12882-019-1315-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 10/23/2017] [Accepted: 03/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Apparent treatment-resistant hypertension (aTRH) is a common condition associated with risk of cardiovascular events. However, the risk of cardiovascular mortality associated with aTRH in the US population is unknown. We aimed to assess the risk of cardiovascular disease (CVD) mortality associated with aTRH in the US population. Methods We analyzed data from 6357 adult hypertensive participants of the National Health and Nutrition Examination Survey (1988–1994 and 1999–2010) linked to the National Death Index. Based on presence of uncontrolled hypertension [blood pressure (BP) ≥140/90 mmHg] and the number of antihypertensives prescribed, we classified participants into the following groups: non-aTRH (BP < 140/90 mmHg and ≤ 3 antihypertensives); controlled aTRH (BP < 140/90 mmHg and ≥ 4 antihypertensives); and uncontrolled aTRH (BP ≥140/90 mmHg and ≥ 3 antihypertensives). Results Of the 6357 participants, 1522 had aTRH, representing a US prevalence of 7.6 million. Of the participants with aTRH, 432 had controlled aTRH and 1090 had uncontrolled aTRH. During follow-up (median 6 years), there were 550 CVD deaths. The cumulative incidence of CVD mortality was significantly higher in the aTRH group compared with non-aTRH group (log-rank p < 0.001). In fully adjusted models, aTRH was associated with a 47% higher risk of CVD mortality compared with the non-aTRH group [1.47 (1.1–1.96)]. Similar increase in risk of CVD mortality was noted across aTRH subgroups compared with the non-aTRH group: controlled aTRH [1.66 (1.03–2.68)] and uncontrolled aTRH [1.43 (1.05–1.94)]. Among non-aTRH subgroups, those on 3 antihypertensive medications had a 35% increased risk of CVD mortality than those on < 3 medications [1.35 (0.98–1.86)]. Conclusions aTRH is a common condition, affecting approximately 7.6 million Americans. Regardless of BP control, people with aTRH remain at a higher risk of cardiovascular outcomes. The risk of cardiovascular disease mortality remains high among those with controlled BP on 3 medications (non-aTRH) or ≥ 4 medications (controlled aTRH), groups not generally considered at high risk. Future risk reduction interventions should consider focusing on these high-risk groups. Electronic supplementary material The online version of this article (10.1186/s12882-019-1315-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katerina R Kaczmarski
- Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD, 21287, USA.
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD, 21287, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jingsha Chen
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yingying Sang
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tariq Shafi
- Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD, 21287, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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AL Mulhim NS, Kehoe PG, Miners JS. Divergence in the activity of the N- and C- catalytic domains of ACE1 - implications for the role of the renin-angiotensin system in Alzheimer's disease. Acta Neuropathol Commun 2019; 7:57. [PMID: 31018864 PMCID: PMC6480511 DOI: 10.1186/s40478-019-0718-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/10/2019] [Indexed: 01/01/2023] Open
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de Moura Leão MF, Duarte JA, Sauzen PD, Piccoli JDCE, de Oliveira LFS, Machado MM. Cytotoxic and genotoxic effects of antihypertensives distributed in Brazil by social programs: Are they safe? Environ Toxicol Pharmacol 2018; 63:1-5. [PMID: 30107356 DOI: 10.1016/j.etap.2018.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 02/14/2018] [Revised: 08/03/2018] [Accepted: 08/08/2018] [Indexed: 06/08/2023]
Abstract
Hypertension, a chronic non-transmissible multifactorial condition, it is highly frequent in Brazil, affecting about 32.5% of the population over 25 years of age. It is characterized by the sustained increase in systolic and diastolic blood pressure levels above 140 mmHg and 90 mmHg, respectively. It is the major aggravating factor in cardiovascular complications and the appearance of other comorbidities. Aiming to promote greater adherence to treatment and improve the population's access to basic medicament, in 2004 the Federal Government created the Programa Farmácia Popular do Brasil (PFPB); partnership with private institutions that provides the population with medicament to control hypertension, free of charge or subsidized at up to 90% of the value. The PFPB distributes the anti-hypertensives atenolol, captopril, enalapril, hydrochlorothiazide, losartan and propranolol. In this way, this work aims to evaluate the genotoxic potential of antihypertensives in human lymphocytes and macrophages, since they are widely used drugs and with few studies about their genotoxicological safety. The tests were developed from cell cultures treated with five different antihypertensive concentrations, all based on plasma peaks, evaluating cell viability, DNA damage index and DNA double strand breakdown. The results show that, as the concentration of captopril and enalapril maleate increased, cell viability decreased. In addition, a DNA damage was observed with the use Captopril and Enalapril in the higher concentrations. Hydrochlorothiazide also caused DNA damage in the five doses tested. Regarding the breaking of double strands of DNA, all the compounds showed increased ruptures. This decrease in dsDNA is dose dependent for all compounds tested. The set of results shows that the use although frequent still requires care and greater knowledge. In general, the antihypertensive drugs that proved to be safer in relation to the genetic damage tested were Losartan and Propranolol.
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Affiliation(s)
- Maria Fernanda de Moura Leão
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Pampa, BR 472, Km 585, Mail box 118, Uruguaiana, RS, CEP: 97500-970, Brazil
| | - Jonathaline Apollo Duarte
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Pampa, BR 472, Km 585, Mail box 118, Uruguaiana, RS, CEP: 97500-970, Brazil
| | - Patrícia Dutra Sauzen
- Pharmacy Course, Federal University of PAMPA, BR 472, Km 585, Caixa postal 118, Uruguaiana, RS, CEP: 97500-970, Brazil
| | - Jacqueline da Costa Escobar Piccoli
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Pampa, BR 472, Km 585, Mail box 118, Uruguaiana, RS, CEP: 97500-970, Brazil; Pharmacy Course, Federal University of PAMPA, BR 472, Km 585, Caixa postal 118, Uruguaiana, RS, CEP: 97500-970, Brazil
| | - Luís Flávio Souza de Oliveira
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Pampa, BR 472, Km 585, Mail box 118, Uruguaiana, RS, CEP: 97500-970, Brazil; Pharmacy Course, Federal University of PAMPA, BR 472, Km 585, Caixa postal 118, Uruguaiana, RS, CEP: 97500-970, Brazil
| | - Michel Mansur Machado
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Pampa, BR 472, Km 585, Mail box 118, Uruguaiana, RS, CEP: 97500-970, Brazil; Pharmacy Course, Federal University of PAMPA, BR 472, Km 585, Caixa postal 118, Uruguaiana, RS, CEP: 97500-970, Brazil.
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Noone C, Dwyer CP, Murphy J, Newell J, Molloy GJ. Comparative effectiveness of physical activity interventions and anti-hypertensive pharmacological interventions in reducing blood pressure in people with hypertension: protocol for a systematic review and network meta-analysis. Syst Rev 2018; 7:128. [PMID: 30131071 PMCID: PMC6103808 DOI: 10.1186/s13643-018-0791-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/31/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The prevalence of hypertension is a major public health challenge. Despite it being highly preventable, hypertension is responsible for a significant proportion of global morbidity and mortality. Common methods for controlling hypertension include prescribing anti-hypertensive medication, a pharmacological approach, and increasing physical activity, a behavioural approach. In general, little is known about the comparative effectiveness of pharmacological and behavioural approaches for reducing blood pressure in hypertension. A previous network meta-analysis suggested that physical activity interventions may be just as effective as many anti-hypertensive medications in preventing mortality; however, this analysis did not provide the comparative effectiveness of these disparate modes of intervention on blood pressure reduction. The primary objective of this study is to use network meta-analysis to compare the relative effectiveness, for blood pressure reduction, of different approaches to increasing physical activity and different first-line anti-hypertensive therapies in people with hypertension. METHODS A systematic review will be conducted to identify studies involving randomised controlled trials which compare different types of physical activity interventions and first-line anti-hypertensive therapy interventions to each other or to other comparators (e.g. placebo, usual care) where blood pressure reduction is the primary outcome. We will search the Cochrane Library, MEDLINE and PsycInfo. For studies which meet our inclusion criteria, two reviewers will extract data independently and assess the quality of the literature using the Cochrane Risk of Bias Tool. Network meta-analyses will be conducted to generate estimates of comparative effectiveness of each intervention class and rankings of their effectiveness, in terms of reduction of both systolic and diastolic blood pressure. DISCUSSION This study will provide evidence regarding the comparability of two common first-line treatment options for people with hypertension. It will also describe the extent to which there is direct evidence regarding the comparative effectiveness of increasing physical activity and initiating anti-hypertensive therapy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017070579.
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Affiliation(s)
- C. Noone
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - C. P. Dwyer
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - J. Murphy
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - J. Newell
- School of Mathematics, Statistics & Applied Mathematics, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - G. J. Molloy
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
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Ramdas D, Chakraborty A, Hs S, Faizan S, Kumar V P, Bn S. A study of package inserts in southern India. J Clin Diagn Res 2013; 7:2475-7. [PMID: 24392376 DOI: 10.7860/jcdr/2013/6353.3583] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 04/28/2013] [Accepted: 08/11/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Package insert is an officially approved document that accompanies a drug. It is intended to provide information for the safe and effective use of a drug and contains information based on regulatory guidelines. Sometimes, information provided in the package inserts is suboptimal which can led to medication errors. This study was undertaken to assess the presentation and completeness of clinical information provided in the currently available package inserts for anti-diabetic, anti-hypertensive and hypolipedemic drugs in India. MATERIAL AND METHODS Around 130 package inserts were collected from pharmacies located at different areas of Bangalore. They were analyzed based on criteria mentioned in Schedule D of Drug and Cosmetic act 1945. RESULTS AND OBSERVATIONS Out of 134 package inserts, 64 were anti-diabetics, 40 anti-hypertensives, and 30 hypolipedemics. Out of them, 31 (23.14%) belonged to Grade 'A' (including all injectable preparations) and remaining 76.86% to Grade 'B'. None of the PIs belonged to Grade 'C'. The inserts were inadequate in many aspects; for example, they had unclear instructions about generic name of other ingredients used, about handling, undesirable effects, pediatric and geriatric use, and guidelines for use of the drugs. CONCLUSION This study indicated that information relevant to the safe and effective use of medication was not mentioned in the analyzed package inserts. It is, therefore, recommended to update the existing package inserts based on criteria mentioned in the Schedule D of Drug and Cosmetic Act, 1945.
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Affiliation(s)
- Deepak Ramdas
- Post Graduate Student, Department of Pharmacology, Vydehi Institute of Medical Sciences and Research Centre Whitefield, Bangalore, India
| | - Ananya Chakraborty
- Associate Professor, Department of Pharmacology, Vydehi Institute of Medical Sciences and Research Centre Whitefield, Bangalore, India
| | - Swaroop Hs
- Post Graduate Student, Department of Pharmacology, Vydehi Institute of Medical Sciences and Research Centre Whitefield, Bangalore, India
| | - Syed Faizan
- Undergraduate Student, Second Year, Vydehi Institute of Medical Sciences and Research Centre Whitefield, Bangalore, India
| | - Praveen Kumar V
- Undergraduate Student, Second Year, Vydehi Institute of Medical Sciences and Research Centre Whitefield, Bangalore, India
| | - Srinivas Bn
- Professor and HOD, Department of Pharmacology, Vydehi Institute of Medical Sciences and Research Centre Whitefield, Bangalore, India
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Abstract
Hypertension is an extremely common co-morbid condition in diabetes leading to acceleration in micro-vascular and macro-vascular complications. The use of anti-hypertensives in diabetic patients should be considered in the context of preventing the development of complications. Various factors contribute to the pathophysiology of diabetes in hypertension. With the advancements in technology, the understanding of the pathophysiological mechanisms has increased, and this can contribute in providing evidence for beneficial role of certain anti-hypertensives. Many clinical trials have been carried out for use of diuretics, beta blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. The present review gives an overview of pathophysiological mechanisms of hypertension and diabetes in addition to the details of clinical trials of anti-hypertensives in diabetic patients. This is an attempt to provide some evidences for the clinicians, which may serve as a guide for use of anti-hypertensives in clinical practice.
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Affiliation(s)
- Bhoomika M Patel
- Department of Pharmacology, L. M. College of Pharmacy, Ahmedabad, Gujarat, India
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Abstract
OBJECTIVE Hypertension is a leading contributor to the global burden of cardiovascular morbidity and mortality. The main objective of the present study was to assess the prescribing patterns for antihypertensives in geriatric patients. MATERIALS AND METHODS A Prospective observational study was carried out for the period of six months in an out-patient department. Elderly patients who have been diagnosed with hypertension as per JNC-7 guidelines and patients receiving or prescribed with antihypertensive drugs were included. RESULTS A total of 100 prescriptions were analyzed during the six-month study period. 72% of the patients were in the age group of 65-67 years and this was found to be higher in men 69%. During the study period 80% of the patients were Pre-Hypertensive systolic (80-89 mmHg) and Diastolic (120-139 mmHg) followed by Stage-I Hypertension and Stage-II Hypertension. The most common drug classes involved in the study was Calcium Channel Blockers 37% followed by Angiotensin II receptor antagonists 21% and the most commonly prescribed drugs in the study population were Amlodipine 37%, Losartan 11% and Telmisartan 10%. The most common anti-hypertensive fixed dose combination therapy involved in the study was Telmisartan + Hydrochlorothiazide 15% and most common two drug combination therapy involved in the study was Amlodipine + Atenolol 7% followed by Metoprolol + Amlodipine 1%. CONCLUSION Our study shows that the most commonly prescribed drug classes involved were Calcium Channel Blockers followed by Angiotensin II receptor antagonists and the anti-hypertensive drug combinations among hypertensive patients were considerable and this practice positively impacted on the overall blood pressure control.
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Affiliation(s)
- Arshad H Mohd
- Department of Pharmacy Practice and Pharm D, St. Peter's Institute of Pharmaceutical Sciences, Kakatiya University, Warangal - 506 001, Andhra Pradesh, India
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