Angiotensin Receptor Antagonists Research Articles

The risk of worsening of myasthenia by cardiovascular medication as reflected by reporting frequency.

Some groups of cardiovascular drugs (beta-blocking drugs, Ca antagonists, antiarrhythmics) are listed as potentially worsening myasthenia. An empirical basis for alternative recommendations for antihypertensive and antiarrhythmic therapy in myasthenia patients has not yet been provided. From the World Health Organization pharmacovigilance database, we retrieved total and myasthenia-related counts of adverse drug reactions for various groups of drugs used in cardiovascular disease and drugs with related mechanism of action used in other indications. We calculated the reporting odds ratio as a measure of a disproportional fraction of myasthenia-related events among all events. A 95% confidence interval of reporting odds ratio (ROR) >1 was taken as an indication for a higher risk. Because our approach involves a considerable number of tests, this situation is referred to as a signal that requires additional confirmation. A signal for an increased risk was noted for tizanidine, for alpha-blocking drugs, for beta-blocking drugs, and for Ca antagonists. ROR indicated a lower-than-average risk for salbutamol, angiotensin receptor antagonists, oral anticoagulants, thrombocytic function inhibitors, and heparins. Angiotensin receptor antagonists, angiotensin-converting enzyme inhibitors, and diuretics seem to be safe in antihypertensive therapy. Surprisingly, and yet requiring confirmation by case reports, alpha receptor-blocking drugs seem to carry a risk of myasthenia worsening. Amiodarone seems to be a safe alternative in antiarrhythmic therapy in patients with myasthenia.

Outpatient cardiac rehabilitation in coronary artery disease: impact on cardiovascular outcomes

Cardiac rehabilitation (CR) is a model of care proven to reduce recurrent cardiovascular events, new hospitalizations and mortality in patients with coronary artery disease. The aim of this study was to describe ambulatory CR in Gualdo-Tadino, ASL1 of Perugia (Italy), analyzing the outcomes of this population at 1 year and in the medium-long term. The clinical instrumental characteristics and the outcome of patients referred to CR after ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), angina, coronary artery bypass graft (CABG), ischemic heart disease have been analyzed. Follow-up interval: 2005-2018. Average follow-up 4.9 ± 4.4 years/patient. Comorbidity, new events, and mortality have been analyzed. From a population of 1552, 1384 were selected with a history of coronary artery disease: age 64.6 ± 9.8 years; 17% female (mean age 67.6 ± 8.8 years); 13.2% elderly >75 years; 57.2% were referred for CR after STEMI, 17.1% after non-STEMI, 19.9% after angina or ischemic heart disease. Patients with CABG were 79 (5.7%), but treatment by CABG was used in 287 patients (20.7%) referred for STEMI, non-STEMI or angina. CR lasted on average about 3 weeks, followed by scheduled periodic visits every 6 months and every 1-2 years thereafter. At the last check, 82.4% of patients were on antiplatelets, 71.1% on beta-blockers, 75.8% on angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, 90.5% on statins or cholesterol-lowering agents, with the following secondary prevention targets: LDL cholesterol 87.5 ± 31.9 mg/dl (target <70 mg/dl in 30.4% of patients) and 78.9 ± 28.7 mg/dl (target <70 mg/dl in 37.2% of patients) in the whole population and in those enrolled since 2010, respectively; heart rate was 63.4 ± 10.8 bpm, systolic and diastolic blood pressure 128.3 ± 15.6/73.6 ± 8.6 mmHg, triglyceridemia 135.6 ± 73.6 mg/dl. Events during the overall follow-up were 156 reinfarctions in 136 patients, 341 coronary angioplasty procedures in 258 patients, angina in 99 patients, CABG in 60 patients, re-CABG in 7 patients, heart failure in 21 patients, stroke in 44 patients. At 1-year follow-up, 10.3% of patients had a new hospitalization for cardiovascular events (1.6%) or coronary angioplasty (8.7%). Peripheral vascular disease, diabetes mellitus and chronic renal failure, analyzed in 627 patients in an average period of 6.5 years, increased by 11.0%, 5.3% and 4.8%, respectively. All-cause mortality over the entire period and at 1 year was 10.5% and 0.7%, respectively. Multivariate analysis shows that the probability of death increases in males, with age, left ventricular dysfunction, peripheral vascular disease, dyslipidemia and diabetes, while it decreases as the number of controls increases. The probability of reinfarction is higher in smoking patients, with renal insufficiency, vascular disease, neoplasms. The study highlights the efficacy of ambulatory CR programs and subsequent follow-up in the treatment of a population with coronary heart disease, risk factors and comorbidities. The increase of comorbidities, particularly peripheral vascular disease, diabetes mellitus and chronic renal failure - along with the non-reduction of smoking - have significantly affected the outcome, despite the effective control of the other coronary risk factors.

Intraoperative floppy iris syndrome: an updated review of literature.

Intraoperative Floppy iris syndrome(IFIS) remains a challenge for surgeons during phacoemulsification. Initially, it was related to the use of tamsulosin, an alpha adrenergic receptor blocker used in benign prostatic hyperplasia. Subsequently, other alpha adrenergic receptor such as alfuzosin, terazosin and doxazosin alongwith different other class of medications and systemic risk factors were identified. Other class of medications includes 5-alpha reductase inhibitor, angiotensin receptor antagonist, benzodiazepines, antipsychotics and antidepressants. Other risk factors include increasing age, male gender, diabetes, hypertension and decreased preoperative pupil diameter. It is very important for surgeons to identify these risk factors preoperatively and take appropriate preoperative and intraoperative measures to tackle the dreaded complications of IFIS. Sometimes, it is important for an ophthalmologist to work in cooperation with physician and urologist to minimize the complications. In conclusion, awareness of the risk factors associated with IFIS, their detailed preoperative assessment and intraoperative measures and surgical intervention is crucial in addressing IFIS. Lack of awareness can turn a routine, uneventful surgery into one with significant visual morbidity.

Clinical characteristics and treatment of outpatients with chronic heart failure in the Moscow Region

Aim: To perform clinical characterization of patients with chronic heart failure (CHF) in the Moscow Region and to assess if their current treatments meet the current clinical guidelines.Materials and methods: Based on the information submitted from 11 outpatient clinics in the Moscow Region in December 2019, we analyzed retrospective data on 286 patients with CHF, including their concomitant diseases, types of assessments and their results, as well as current treatments.Results: The most common concomitant disease was arterial hypertension (95.1% of the patients). 53.8% of the patients had previous myocardial infarction, 37.8%, diabetes mellitus, and 34.6%, atrial fibrillation. Chronic kidney disease was present in 18.5% of the patients, valvular heart disease in 11.9%, and past stroke in 10.5%. Of non-cardiovascular diseases, the most common were gastrointestinal disorders (25.2%), chronic obstructive pulmonary disease or asthma (9.8%), and anemia (5.2%). Only 8% of the patients had one concomitant disease, whereas 72% had 2 to 3 diseases, and 20% had at least 4 concomitant diseases. Mean number of comorbidities per patient was 2.7. Echocardiography had been performed in 82.9% of the cases. Mean left ventricular ejection fraction was 51.0±10.11%; in 11.5% of the patients it was≤40%. Glomerular filtration rate (GFR) was calculated in 58.7% of the patients. 35.9% of the patients had a GFR of less than 60 mL/min/1.73 m2 , in 3.6% it was≤30 mL/min/1.73 m2 . 83.2% of the patients were treated with renin angiotensin aldosterone system blockers (angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, sacubitril/valsartan), 79.0% with beta-blockers, 53.1% with mineralocorticoid receptor antagonists. Glycosides had been administered to 6.9% of the patients, and diuretics, to 51.1%. In most cases, the doses administered were below those recommended by the international clinical guidelines.Conclusion: We have confirmed the need to increase the adherence of doctors to the clinical guidelines on assessment and management of CHF patients.

Preparation, Characterization and Optimization of Irbesartan Loaded Solid Lipid Nanoparticles for Oral Delivery

The purpose of this study was to develop and evaluate irbesartan (IS) loaded solid lipid nanoparticles (SLNs; IS-SLNs) that might enhance the oral bioavailability of IS. IS, an angiotensin-receptor antagonist, used to treat hypertension. However, poor aqueous solubility and poor oral bioavailability has limited therapeutic applications of IS. Components of the SLNs include either of trimyristin/tripalmitin/tristearin/trilaurate/stearic acid/beeswax, and surfactants (Poloxamer 188 and soylecithin). The IS-SLNs were prepared by hot homogenization followed by ultrasonication method and evaluated for particle size, poly dispersity index (PDI), zeta potential (ZP), entrapment efficiency (EE), drug content and in vitro drug release. The physical stability of optimized formulation was studied at refrigerated and room temperature for two months. The optimized IS-SLN formulation (F4) had a mean diameter of about 217.6±3.62 nm, PDI of 0.163±0.032, ZP of -28.5±4.12, assay of 99.8±0.51 and EE of 93.68±2.47%. The formulation showed sustained drug release compared with control formulation over 24 h. Optimized formulation was found to be stable over two months. IS-SLN showed nearly spherical in shape using and converted to amorphous form by DSC. Thus, the results conclusively demonstrated SLNs could be considered as an alternative delivery system for the oral bioavailability enhancement of IS.

Patient, hospital and country-level risk factors of all-cause mortality among patients with chronic heart failure: Prospective international cohort study.

Although many studies have described patient-level risk factors for outcomes in heart failure (HF), health care structural determinants remain largely unexplored. This research reports patient-, hospital- and country-level characteristics associated with 1-year all-cause mortality among patients with chronic HF, and investigates geographic and hospital variation in mortality. We included 9,277 patients with chronic HF enrolled between May 2011 and November 2017 in the prospective cohort study European Society of Cardiology Heart Failure Long Term registry across 142 hospitals, located in 22 countries. Mean age of the selected outpatients was 65 years (sd 13.2) and 28% were female. The all-cause 1-year mortality rate per 100 person-years was 7.1 (95% confidence interval (CI) 6.6-7.7), and varied between countries (median 6.8, IQR 5.6-11.2) and hospitals (median 7.8, IQR 5.2-12.4). Mortality was associated with age (incidence rate ratio 1.03, 95% CI 1.02-1.04), diabetes mellitus (1.37, 1.15-1.63), peripheral artery disease (1.56, 1.27-1.92), New York Heart Association class III/IV (1.91, 1.60-2.30), treatment with angiotensin-converting enzyme inhibitor and angiotensin receptor antagonists (0.71, 0.57-0.87) and HF clinic (0.64, 0.46-0.89). No other hospital-level characteristics, and no country-level healthcare characteristics were associated with 1-year mortality, with case-mix standardised variance between countries being very low (1.83e-06) and higher for hospitals (0.372). All-cause mortality at 1 year among outpatients with chronic HF varies between countries and hospitals, and is associated with patient characteristics and the availability of hospital HF clinics. After full adjustment for clinical, hospital and country variables, between-country variance was negligible while between-hospital variance was evident.

Effects of Sodium Glucose Cotransporter 2 Inhibitor on Renal Renin-Angiotensin-Aldsoterone System

Objective: The renoprotective effect of sodium glucose cotransporter 2 inhibitor (SGL2i) has been reported in diabetic patients. Local renin-angiotensin-aldosterone system (RAAS) is activated in diabetes mellitus and hypertension. We examined the effects of SGL2i on the RAAS in the obese diabetic rats fed a high salt diet. Methods: Zucker-diabetic rats (ZDR) and control rats were fed a high or normal salt diet and were treated with canagliflozin for 8 weeks. Blood pressure (BP), blood glucose (BG), PRA, plasma aldosterone (PAC), urinary albumin excretion (UAE), urinary 8-hydroxy-2’-deoxyguanosine (8-OHdG), gene expression of angiotensinogen in the kidney were measured. Results: ZDR febd a high salt diet showed high BP, increased UAE and urinary 8-OHdG and elevated angiotensinogen mRNA levels. Treatment with canagliflozin significantly decreased BP, BG, UAE, urinary 8-OHdG and and renal angiotensinogen mRNA levels compared with control rats (p<0.05). Discussion and Conclusion: The closer mechanism of renoptotection of SGL2i in diabetes mellitus is unclear. We have reported that the repoprotective effects of type 2 angiotensin receptor antagonist or mineralocorticoid receptor blocker were partly due to the decreased RAAS in the kidney. Decreased renal RAAS by the treatment with canagliflozin may contribute to the renoprotection in DZR.

Suoquan pill for the treatment of diabetic nephropathy: A protocol for systematic review and meta-analysis.

Background:Diabetic nephropathy (DN) is one of the most common complications of diabetes and the main cause of kidney failure in developed countries. Clinically, DN is usually treated by controlling blood sugar and blood pressure. According to reports, the application of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist can only target a certain stage of disease development. However, the application of Suoquan Pill (SQP) in traditional Chinese medicine has produced obvious clinical effects and minor side effects. It is used to treat DN and other diseases, but there is no systematic review of SQP in the treatment of diabetic nephropathy. This article reviews the effectiveness and safety of SQP in the treatment of DN.Methods:The database sets the registration date for randomized controlled trials (RCT) to March 25, 2021. By searching the following eight Chinese and English electronic databases: Cochrane Library, Embase, PubMed, Science Net, China National Knowledge Infrastructure, China Biomedical Literature Database. Chinese scientific journal database and Wanfang database for analysis. The main results are clinical efficacy, urinary albumin excretion rate, symptom score and quality of life. Finally, Stata 15 was used for meta-analysis.Results:This study will provide the latest evidence for SQP in the treatment of DN in the following aspects: clinical efficacy, urinary albumin excretion rate, quality of life, symptom score.Conclusion:The results of this study will provide evidence for evaluating the effectiveness of SQP in the treatment of DN.OSF registration number:10.17605/OSF.IO/KZ9RA

Non-steroidal anti-inflammatory drugs and arterial hypertension: drug interaction-adjusted management of patients

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most common drugs in clinical practice and account for 5–10% of all drugs prescribed each year. However, the use of this group of drugs is associated with the risk of a wide range of side effects, most of which are cardiovascular complications. In addition, NSAIDs interact with other drugs, for example, their effect on antihypertensive therapy has recently been recognized as particularly important. Improvement of not only efficacy, but also safety is another important principle of rational pharmacotherapy. Adverse drug reactions (ADR) can very often result from underlying genetic factors of the human body. In this regard, a personalized approach suggesting the prescription of drugs according to the individual characteristics of patients is especially important. In such cases, pharmacogenetic testing is the most promising method that identifies the genetic factors of patients and allows to predict patients’ responses to specific drugs. This applies especially to a large range of drugs metabolised via the cytochrome P450 system in the liver. Results from numerous studies show that the effect of P450 family gene polymorphism determines the individual sensitivity to antihypertensive drugs, as it is these isozymes that are involved in the metabolism of drugs used to treat arterial hypertension (AH). In particular, the cytochrome (CYP) 450 isoenzyme is one of the basic enzymes involved in the biotransformation of losartan, an angiotensin receptor antagonist. Therefore, the CYP2C9 gene polymorphism largely determines the pharmacological response to NSAIDs and affects the effectiveness of antihypertensive therapy due to the change in the drug metabolism, as well as the structure and function of the receptors, on which they have an effect.

PREVALENCE AND PREDICTORS OF ADVERSE DRUG REACTIONS IN OLDER HYPERTENSIVE ADULTS

Objective: Polipharmacy is common in older people, thus increasing the risk of adverse drufg reactrions. This study aimed to analyse prevalence and predictors of the most relevant adverse drug reactions in older hypertensive adults. Design and method: We retrospectively analysed data on antihypertensive- and statin-related adverse drug reactions in adults aged 65 or older evaluated at the Hypertension Clinic of Careggi Hospital, Florance, Italy, between January 2018 and December 2019. Predictors were investigated using multivariate logistic regression. Results: Of 262 participants (mean age 75.9 years, 55.3% female), the 19% of the patients taking ACE-inhibitors reported cough while 33.6% of the patients taking calcium channel blockers (CCB) reported peripheral edema, occuring more frequently of amlodipine. The prevalence of statin-related myalgia was 23.5%. At multivariate analysis SNRI antidepressants and gastroesophageal reflux disease (GERD) were predictive of ACE-inibitors induced cough (OR 16.220, 95% CI 1.243 – 211.621; OR 4.207, 95% CI 1.249 – 4.171, respectively) and angiotensin-receptor antagonists were associated with an increased risk of peripheral edema on CCB (OR 2.500, 95% CI 1.095 - 5.710). GERD was predictive for statin-induced myalgia (OR 6.737, 95% CI 1.530 - 29.662). Conclusions: ACE inhibitor-induced cough, CCB-related peripheral edema and statin-induced myalgia are common in older hypertensive adults. SNRI antidepressants and GERD are independently associated with ACE inhibitor-induced cough, while angiotensin-receptor antagonists are predictive of CCB-related peripheral edema. GERD is also associated with statin myalgia.

THE SAFETY OF ANTIHYPERTENSIVE AGENTS ON PERIOPERATION OF CARDIAC SURGERY: A SYSTEMATIC REVIEW BASED ON META-ANALYSIS

Objective: To assess the safety of anti-hypertensive agents including calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists (ACEIs/ARBs), and beta blockers during perioperation of cardiac surgery. Design and method: We included randomized controlled trials investigating perioperative application of CCBs, ACEIs/ARBs or beta blockers in cardiac surgery. We extracted data for in-hospital mortality and serious side effects, among which atrial fibrillation (AF), stroke and acute renal failure (ARF) were assessed independently. Results: Twenty-three trials with 5378 patients were included. There were no significant differences between CCBs and placebo, nitroglycerin, or nitroprusside in terms of side effects, AF and ARF. Incidences of side effects (RR [95% CI] 0.55 [0.38, 0.80], I2=0, p &lt; 0.01) and ARF (RR [95% CI] 0.16 [0.05, 0.53], I2=0, p &lt; 0.01) were significantly reduced in ACEIs/ARBs group, compared with placebo, while differences in the incidences of AF and stoke were not found. No differences were found in the incidences of in-hospital death, side effects, ARF and stroke between beta blockers and placebo. However, use of beta blockers significantly reduced the incidence of AF (RR [95% CI] 0.51 [0.39, 0.67], I2=48%, p &lt; 0.01). Conclusions: Perioperative use of CCBs, ACEIs/ARBs or beta blockers does not increase incidences of side effects in patients undergoing cardiac surgery and beta blockers are more appropriate in patients with high risk of postoperative atrial tachycardia. Large randomized trials are needed to confirm these findings.

A Multi-Objective Approach for Drug Repurposing in Preeclampsia.

Preeclampsia is a hypertensive disorder that occurs during pregnancy. It is a complex disease with unknown pathogenesis and the leading cause of fetal and maternal mortality during pregnancy. Using all drugs currently under clinical trial for preeclampsia, we extracted all their possible targets from the DrugBank and ChEMBL databases and labeled them as “targets”. The proteins labeled as “off-targets” were extracted in the same way but while taking all antihypertensive drugs which are inhibitors of ACE and/or angiotensin receptor antagonist as query molecules. Classification models were obtained for each of the 55 total proteins (45 targets and 10 off-targets) using the TPOT pipeline optimization tool. The average accuracy of the models in predicting the external dataset for targets and off-targets was 0.830 and 0.850, respectively. The combinations of models maximizing their virtual screening performance were explored by combining the desirability function and genetic algorithms. The virtual screening performance metrics for the best model were: the Boltzmann-Enhanced Discrimination of ROC (BEDROC)α=160.9 = 0.258, the Enrichment Factor (EF)1% = 31.55 and the Area Under the Accumulation Curve (AUAC) = 0.831. The most relevant targets for preeclampsia were: AR, VDR, SLC6A2, NOS3 and CHRM4, while ABCG2, ERBB2, CES1 and REN led to the most relevant off-targets. A virtual screening of the DrugBank database identified estradiol, estriol, vitamins E and D, lynestrenol, mifrepristone, simvastatin, ambroxol, and some antibiotics and antiparasitics as drugs with potential application in the treatment of preeclampsia.

Ambulatory blood pressure monitoring in the diagnosis and management of arterial hypertension in current medical practice in Algeria

There are limited data on the management of hypertension (HT) in Algeria. The aim of this study was to assess in current medical practice the use and benefits of ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of HT. A prospective, observational, multicenter study was performed in 2017. Patients aged ≥ 18 years with suspected or treated HT were included. A 24-hour ABPM was performed at baseline in all patients. Therapeutic decision was taken according to ABPM results and patients were then followed up to 6 weeks. The analysis included 1027 patients (mean age, 51.0 years; women, 61.6%) with treated HT (37.3%) or suspected HT (62.7%). Major cardiovascular risk factors were diabetes (15.7%) and lipid disorders (7.2%). Daytime ABPM was pathological in 55.1% of patients on antihypertensive treatment and in 60.8% of patients with suspected HT. A therapeutic adjustment or a treatment switch was performed after ABPM in 65.4% of patients already on antihypertensive treatment and an antihypertensive therapy was initiated in 88.9% of patients with initially suspected HT. Therapeutic strategy was mainly based on monotherapy regimen in 35.8% of patients with treated HT and in 69.3% of patients with initial suspicion of HT. Most frequent treatments were angiotensin receptor antagonists (55.3% and 50.0%, respectively). Comparable findings were observed 6 weeks later. Our results confirm that ABPM is a highly valuable method in diagnosing and confirming HT, as well as in guiding and assessing antihypertensive therapy.

Evaluation of anticonvulsant activity of angiotensin receptor antagonists in an animal model

Background: Epilepsy is common chronic disorder in clinical practice and there was some studies which shows brain renin angiotensin system may be involved in upregulation of seizures hence present study was planned to investigate whether angiotensin II AT1 receptor antagonists possess anticonvulsant activity in experimental animals.Methods: The anticonvulsant activity of angiotensin receptor antagonists, losartan (50 mg/kg), telmisartan (30 mg/kg) and candesartan (20 mg/kg), were administered intraperitoneally to the mice and evaluated by using maximum electroshock (MES) and pentylenetetrazol induced seizures (PTZ) seizure methods. The standard was taken as phenytoin for MES and diazepam for PTZ method. Motor impairment of performance was assessed by the inverted screen test and spontaneous motor activity with digital actophotometer.Results: Losartan demonstrated the anticonvulsant efficacy in MES and PTZ models. Telmisartan and candesartan have anticonvulsant activity in MES induced seizures, but did not show protection against pentylenetetrazol induced seizures. Losartan at dose 50 mg/kg prolonged the mean latency to convulsion (p&lt;0.01) and mean number of convulsions also significantly reduced (p&lt;0.05) convulsions in the mice. Telmisartan and candesartan at dose 30 mg/kg and 20 mg/kg respectively showed significant prolongation in mean latency to convulsion (p&lt;0.05). None of the test drugs i.e. angiotensin receptor antagonists showed significant motor impairment.Conclusions: Angiotensin receptor antagonists: losartan, telmisartan and candesartan had showed anticonvulsant activity in PTZ and MES seizure methods. The exact mechanism of action of their anticonvulsant action not precisely known and hence there is more studies need to test it in various other animal anticonvulsant models.

CARDIORENAL SYNDROME: THE REVIEW OF CURRENT UNDERSTANDING

Introduction. The kidneys and heart rely on each other to function properly. For the kidneys to function, they require adequate blood flow, oxygen delivery and nutrients. If heart failure develops, cardiac output is reduced, which results in decreased renal blood flow, which can lead to reversible and sometimes irreversible kidney damage. For the heart to function, regulation of extracellular volume is required. If the extracellular volume is too low, the volume of blood is insufficient to maintain cardiac output, and if the extracellular volume is too large, fluid leaks out of the capillaries, resulting in edema.Purpose. To study the relationship of the dynamic balance of the “kidney-heart” system in health and disease.Material and methods. Review of modern and foreign literary sources; methods – description, analysis, abstracting.Results and its discussion. 5 forms of cardiorenal syndrome, peculiarities of classification, pathogenesis, clinical manifestations, dynamics of imbalance in the “kidney-heart” system, issues of correction of these disorders are analyzed. They include the treatment of kidney diseases and cardiovascular pathology, prevention of the development of cardiovascular failure in accordance with modern recommendations; diet; quitting smoking, alcohol, nephrotoxic substances; control of body weight, blood pressure, glycemia; the use of angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists or angiotensin receptor blockers, statins; decrease in intra-abdominal pressure and others.Findings. Approaches to the prevention and treatment of cardiorenal syndrome in patients with kidney and heart damage are important. It is necessary to develop and introduce new approaches to nephroprotection in patients with cardiorenal syndrome, which is possible with the joint work of a multidisciplinary team.

Complete Remission of Proteinuria in Patients with Focal Segmental Glomerulosclerosis Treated with Sparsentan, a Dual Endothelin and Angiotensin Receptor Antagonist, in the DUET Trial

Complete Remission of Proteinuria in Patients with Focal Segmental Glomerulosclerosis Treated with Sparsentan, a Dual Endothelin and Angiotensin Receptor Antagonist, in the DUET Trial

An Analysis of Medication Prescriptions for Hypertension in Urban and Rural Residents in Tianjin.

This study aims to examine the medication prescriptions for hypertension in Tianjin. Patients with hypertension in Tianjin were enrolled in this study. The patients' ages ranged from 35 to 75years. A questionnaire survey and physical examination were completed to collect clinical data. Thereafter, a statistical analysis of the medication prescriptions was conducted with different age groups and different grades of hypertension. The results show that, in the total population, and for the young, middle-aged, and older groups, the proportions of single-drug use were 62.97%, 59.26%, 62.76%, and 63.49%, respectively, and the highest rate was for calcium channel blocker (CCB) use. The rates of the two drug classes were 24.51%, 29.63%, 25.13%, and 23.15%, respectively. The drug use rate of CCBs combined with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor antagonists (ARBs) was the highest. The rates of the three drug classes were 4.08%, 4.94%, 4.36%, and 3.52%, respectively, and the highest was ACEI/ARB and CCB combined with diuretics. The rates of the four drug classes were low. Regarding the hypertension grade, in grade 1, grade 2, and grade 3, the rates of single-drug use were 63.53%, 62.69%, and 58.38%, respectively. The rates of the two drug classes were 24.62%, 23.97%, and 25.05%, while the rates of the three drug classes were 3.86%, 4.39%, and 5.34%, respectively. The rate of single-drug use was high, and the rate of combined drug use in the youth group was slightly higher than in the middle-aged and older age groups. The combination of two drugs was common. In grades 2 and 3 hypertension, the rate of combined drug use remained low.

Central serous chorioretinopathy induced by drugs metabolized by cytochrome P450 3A4.

The purpose of this study was investigate whether replacing or discontinuing drugs that are inhibitors or substrates of cytochrome P450 3A4 (CYP3A4) may improve the clinical course of central serous chorioretinopathy (CSC). A retrospective observational study included 43 patients with active CSC. Twenty seven patients (32 eyes, group 1) were using drugs that act as substrates or inhibitors of CYP3A4. In 25 of these 27 patients, treatments including steroids, calcium channel blockers, anticoagulants, statins, beta-adrenolytics, angiotensin receptor antagonists, antidepressants, muscarinic receptor antagonists, phosphodiesterase type 5 inhibitors, and others were discontinued or replaced with medications not affecting CYP3A4. Sixteen patients (19 eyes, group 2) not using any medication that affects CYP3A4, were given eplerenone, rifampicin, or laser treatment. Main outcomes measures were assessed by functional and anatomical images obtained using multimodal imaging techniques. The average follow-up time was 12 months. In group I after discontinuing or replacing substrates or inhibitors of CYP3A4, improvements were observed in 18 patients (22 eyes). None of the patients that were using drugs affecting CYP3A4 improved with eplerenone therapy, however, all 18 patients improved after discontinuing the drugs. All these drugs had a blocking effect on eplerenone therapy. Best corrected visual acuity (BCVA) improved in 14 eyes, remained unchanged in 5 eyes, and worsened in 3 eyes. In 21 of the 22 eyes, subretinal fluid absorption was observed with optical coherence tomography (OCT). Mean central retinal thickness decreased from 361 μm to 219 μm. One patient (2 eyes) was unable to change treatment (due to neoplasm), one patient (1 eye) did not agree to change or stop treatment, and seven patients (7 eyes) were lost to follow-up. Of the 16 patients (19 eyes) who were treated with eplerenone, rifampicin, or laser, improvements were observed in 14 patients (16 eyes), two patients (2 eyes) were lost to follow-up, and CSC worsened in 1 eye. We concluded that patients with CSC should not take substrates or inhibitors of CYP3A4. These drugs should be replaced with alternatives that act through other metabolic pathways.

Management of proteinuria: blockade of the renin-angiotensin-aldosterone system.

SUMMARYProteinuria, in particular albuminuria, is a potentially significant modifiable risk factor for cardiovascular disease and the progression of kidney disease.Current treatment guidelines for albuminuria recommend a single renin–angiotensin–aldosterone inhibitor. This can be an ACE inhibitor or an angiotensin receptor antagonist.The routine use of combined renin–angiotensin–aldosterone inhibition for albuminuria is not supported by current evidence. Combination therapy is associated with higher rates of adverse events such as hyperkalaemia and progressive renal impairment.

GENES and In-Stent Restenosis: Review

The initiation of coronary stents is a vast landmark in the practice of interventional cardiology. The vascular injury sustained during the percutaneous coronary intervention (PCI) leads to a complicated inflammatory and repairing process. Therefore, stent restenosis arises. Diabetes mellitus is the highest-risk clinical predictor of ISR. Genetics has an important role in the development of ISR. There is a suggested association between the appearance of stent restenosis and certain genetic polymorphisms. Examples of these single nucleotide polymorphisms are endothelial nitric oxide synthase gene (eNOS), the angiotensin converting enzyme gene (ACE), the angiotensin II type 1 receptor gene (AT1R), TGF-β, and VEGF. CYP2C19 variants can help change the medical strategy to a more individualized therapeutic regimen either by altering the therapeutic dose depending on the genotype or using an alternative drug that does not worsen the patient’s case. However, eNOS polymorphism produces gene expression alteration leading to ISR following stent placement. In addition, the deletion-allele of the ACE genotype increases the risk of ISR; however, the I allele decreases the risk. Moreover, the D/I polymorphism is not an independent factor of ISR in patients administering ACE inhibitors or angiotensin receptor antagonists. Furthermore, studies on large sample sizes are required to decrease the harmful adverse effects of stent restenosis by detecting these allele gene polymorphisms.