Effects Of Antihypertensive Agents Research Articles

Shock Patients and Enteral Nutrition?

Shock is a life-threatening condition characterized by microcirculatory disturbances and inadequate tissue perfusion. In hemodynamically unstable individuals, arterial pressure is maintained with vasoactive agents. Enteral nutrition (EN) is crucial for the intensive treatment of critically ill patients, facilitating intestinal recovery and improving clinical outcomes such as reducing infections, shortening hospital stays, and lowering costs. The impact of vasoactive agents on gastrointestinal blood flow varies, depending on the drug, dose, body size, and individual sensitivity. EN is categorized into early and delayed, and multiple guidelines recommend delayed EN due to the risks in the early stage, which may lead to EFI, non-obstructive mesenteric ischemia and necrosis. Guidelines for early EN in shock patients are still evolving, exploring the optimal timing and safety thresholds. Studies have shown that early EN can be safely implemented in hemodynamically stable patients maintaining a mean arterial pressure of 70 mmHg with stable doses of antihypertensives. This review summarizes the optimal and safe timing of initiating EN in shock patients to guide clinical practice. The pathophysiology of shock, EN selection, considerations, nutritional regimens, effects of antihypertensive agents, and feeding regimens are further discussed.

Prescribing Pattern and Effectiveness of Antihypertensives in Patients Suffering from Hypertension to Diabetes Mellitus with and without Compelling Indications in Tertiary Care Hospital.

Aim: The prevalence of hypertension (HTN) and diabetes mellitus (DM) is increasing worldwide, and their coexistence is well-documented. Managing both conditions is challenging due to shared pathophysiological mechanisms and the need to balance blood pressure (BP) control with glycemic management. The objective of this protocol was to consider the prescribing pattern and effectiveness of antihypertensive agents in hypertensive and diabetic patients, with and without compelling indications, at tertiary care hospital. Materials and methods: A prospective, observational study was conducted over 6 months in total 226 diabetic hypertensive patients from a tertiary care hospital. Demographic and medication history data were collected using a self-designed patient profile form. Descriptive statistics were used to analyze the data, and the results were expressed as percentages or means with standard deviations. Results: A total of 226 patients were included in the study, with 62% males and 38% females. 73% of patients were classified as stage 1 and 27% as stage 2 HTN. Among the prescribed antihypertensive agents, β-blockers (BBs) were the most prescribed, followed by angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), diuretics, and other classes. Combination therapy was predominantly used, with dual-drug therapy being the most common. Compelling indications for antihypertensive treatment included ischemic heart disease (IHD) (38.49%), chronic kidney disease (CKD) (12.38%), and stroke (6.63%). The choice of antihypertensive agents varied based on the presence of compelling indications, with BBs and ARBs being frequently prescribed. BP control was achieved in 93% of the patients, with 85.96% of patients with HTN + DM, and 82.84% of patients with additional compelling indications having controlled BP. Conclusion: Therefore, it can be concluded that the antihypertensive medications prescribed to the study adhered to guidelines and that long-term use of these combinations proved to be more effective, safe, and well-tolerated for patients with HTN and DM with or without convincing indications. Adopting the best approach to managing HTN in people with diabetes is crucial for ameliorating patient outcomes and enhancing overall quality of life.

Effect of antihypertensive agents on sleep apnea and ambulatory blood pressure in patients with hypertension: A randomized controlled trial

BackgroundObstructive sleep apnea (OSA) and hypertension are common conditions that may be linked through sympathetic activation and water retention. We hypothesized that diuretics, which reduce the body water content, may be more effective than amlodipine, a blood pressure (BP)-lowering agent implicated with edema, in controlling OSA in patients with hypertension. We also aimed to compare the effects of these treatments on ambulatory blood pressure monitoring (ABPM). MethodsIn a randomized, double-blind clinical trial, we compared the effects of chlorthalidone/amiloride 25/5 mg with amlodipine 10 mg on OSA measured by portable sleep monitor and BP measured by ABPM. The study included participants older than 40 who had moderate OSA (10–40 apneas/hour of sleep) and BP within the systolic range of 140–159 mmHg or diastolic range of 90–99 mmHg. ResultsThe individuals in the experimental groups were comparable in age, gender, and other relevant characteristics. Neither the combination of diuretics nor amlodipine alone reduced the AHI after 8 weeks of treatment (AHI 26.3 with diuretics and 25.0 with amlodipine. P = 0.713). Both treatments significantly lowered office, 24-h, and nighttime ABP, but the two groups had no significant difference. ConclusionChlorthalidone associated with amiloride and amlodipine are ineffective in decreasing the frequency of sleep apnea episodes in patients with moderate OSA and hypertension. Both treatments have comparable effects in lowering both office and ambulatory blood pressure. The notion that treatments could offer benefits for both OSA and hypertension remains to be demonstrated. Trial registration clinicaltrials. gov identifierNCT01896661.

Effects of Antihypertensive Agents on the Clinical Outcome of Hospitalized COVID-19 Patients Concomitant with Hypertension: A Systematic Review and Meta-Analysis

BackgroundGiven the ongoing COVID-19 pandemic, it is crucial to prioritize the management of underlying diseases in infected patients, with hypertension being one of the most common conditions. However, there lies a complicated correlation between antihypertensive agents and COVID-19 infection. ObjectivesThis study is to systematically evaluate the impact of continuing or discontinuing antihypertensive agents on mortality and infection severity in hospitalized patients with both hypertension and COVID-19. MethodsA systematic electronic search was conducted on PubMed, Embase, Cochrane, Web of Science, and ClinicalTrials.gov to identify relevant clinical trials published between 1948 and September 2022. Two independent reviewers assessed the quality of the included studies and extracted relevant data. The primary outcome of interest was the relationship between in-hospital mortality and administration of antihypertensive agents. ResultsThe meta-analysis revealed that continuous administration of antihypertensive agents, compared with discontinuation, significantly reduced in-hospital mortality among hypertension patients with COVID-19 infection [OR=0.49, 95 %CI (0.38, 0.65), p < 0.001, I2=65.3 %]. Specifically, patients receiving ACEI/ARB type agents had even lower mortality rates. Meta-regression analyses were conducted to examine the impact of publication date, sample size, study design, and mean age of the patients, and the results showed that the number of participants in the included studies was the primary source of heterogeneity (p = 0.032). The findings indicated a clear association between the use of antihypertensive agents and reduced mortality in these patients. Conclusionnder the current circumstance of the sustained COVID-19 pandemic, it is recommended to continue the use of antihypertensive agents for patients with hypertension during COVID-19 infection, as it can help reduce the risk of mortality.

GINSENOSIDE-RG3 ENHANCES SOME ANTIHYPERTENSIVE AGENTS-INDUCED INHIBITION OF ADRENAL CATECHOLAMINE SECRETION

Objective: The present study was designed to examine the influence of ginsenoside-Rg3 (Rg3), one of panaxadiol-type saponins, which is isolated from Korean Panax ginseng, in some antihypertensive agents-induced inhibition on the secretion of catecholamines (CA) from the perfused rat adrenal medullae. Design and method: The adrenal gland was isolated and perfused with Krebs-bicarbonate. CA was measured directly by using the fluorospectrophotometer. Results: Ginsenoside-Rg3 (3∼30 μM) during perfusion into an adrenal vein for 90 min significantly inhibited the CA secretion evoked by acetylcholine (ACh). Also, olmesartan (AT1 receptor blocker, 15 μM), simvastatin (an inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, 60 μM), enalapril (an inhibitor of angiotensin converting enzyme, 150 μM), and cilnidipine (a voltage-dependent L-type Ca2+ channel blocker, 3 μM) significantly reduced the CA secretion evoked by ACh and angiotensin II (Ang II), respectively. In the simultaneous presence of ginsenoside-Rg3 (10 μM) along with four antihypertensive agents (olmesartan, enalapril, simvastatin or cilnidipine), the CA secretion evoked by ACh and Ang II was more strongly inhibited compared with that of each antihypertensive agent-treatment alone. Conclusions: Collectively, these results demonstrate that ginsenoside-Rg3 as well as antihypertensive agents can inhibit the CA secretion evoked by activation of both cholinergic and AT1 receptors from the perfused rat adrenal medulla. When this ginsenoside-Rg3 was used in combination with different antihypertensive agents, their effects of antihypertensive agents on reduction of adrenal CA secretion were significantly enhanced, which may also be clinically beneficial for the treatment of cardiovascular diseases.

Effectiveness of antihypertensive agents in stage I/II hypertensive patients with ace (I/D) gene polymorphism

Background: Angiotensin converting enzyme (ACE) is the key enzyme, regulates the blood pressure which is encoded by 21kb gene that consists of 26 exons and is located on chromosome 17, contains a polymorphism in the form of either Insertion (I) or Deletion (D). The aim was to study the effect of antihypertensive drugs in patients of essential hypertension associated with ACE gene polymorphism. Methods: Hypertensive patients were recruited followed by genetic test was done for detecting ACE gene polymorphism, then patients were divided as Group-A &amp; B. Group –A and B patients were treated with atenolol (25mg) and azilsartan (40 mg) for three months respectively. Results: Systolic and diastolic blood pressure was recorded in both the groups before and after commencement of treatment. Among 88 patients of newly diagnosed hypertension, majority of study population belongs to genotype D/D (38.63%) followed by I/D (31.81%) and II (29.54%) genotype. Significant difference was found in systolic blood pressure (p&lt;0.05) of both groups but not diastolic blood pressure (p&gt;0.05). Conclusion: The rate of control of blood pressure was high in I/I genotype followed by D/D genotype irrespective of treatment group. Overall better prognosis was observed with azilsartan 40mg compared to atenolol 25mg treatment in patients with ACE gene polymorphisms.

PS-BPB04-3: ENHANCEMENT EFFECTS OF GINSENOSIDE-RG2 ON SOME ANTIHYPERTENSIVE AGENTS-INDUCED SUPPRESSION OF ADRENAL CATECHOLAMINE RELEASE

Objective: The present study was aimed to investigate the effects of ginsenoside-Rg2 (Rg2), one of panaxadiol-type saponins, which is isolated from Korean Red ginseng, in some antihypertensive agents-induced reduction on the release of catecholamines (CA) from the perfused model of the rat adrenal medullae. Design and Methods: The adrenal gland was isolated and perfused with Krebs-bicarbonate. The CA amoiunt in the perfusate was measured directly by using the fluorospectrophotometer. Results: Ginsenoside-Rg2 (3∼30 μM) during perfusion into an adrenal vein for 90 min significantly inhibited the CA secretion evoked by acetylcholine (ACh) in a dose- and time-dependent fashion. Also, olmesartan (AT1 receptor blocker, 15 μM), simvastatin (an inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, 60 μM), enalapril (an inhibitor of angiotensin converting enzyme, 150 μM), and cilnidipine (a voltage-dependent L-type Ca2+ channel blocker, 3 μM) significantly reduced the CA secretion evoked by ACh and angiotensin II (Ang II), respectively. In the simultaneous presence of ginsenoside-Rg2 (10 μM) along with four antihypertensive agents (olmesartan, enalapril, simvastatin or cilnidipine), the CA secretion evoked by ACh and Ang II was more strongly inhibited compared with that of each antihypertensive agent-treatment alone. Conclusion: Collectively, these results demonstrate that ginsenoside-Rg2 as well as antihypertensive agents can inhibit the CA secretion evoked by activation of both cholinergic and AT1 receptors from the perfused rat adrenal medulla. When this ginsenoside-Rg2 was used in combination with different antihypertensive agents, their effects of antihypertensive agents on reduction of adrenal CA secretion were significantly enhanced, which may also be clinically beneficial for the treatment of cardiovascular diseases.

Relationship Between Resting Heart Rate and Microalbuminuria in Adults With Hypertension: National Health and Nutrition Examination Survey 2009-2018.

BackgroundThe impact of elevated resting heart rate on early-stage renal dysfunction, manifesting as microalbuminuria, in hypertension is unclear. This study aimed to analyze the association between resting heart rate and microalbuminuria in patients with hypertension according to their blood pressure status. In addition, the effect of antihypertensive agents on this relationship was evaluated.Methods and ResultsWe searched the National Health and Nutrition Examination Survey for eligible participants from 2009 to 2018. Data on key parameters such as age, sex, blood pressure, heart rate, albumin creatinine ratio, and medication were collected for analysis. Subsequently, participants were classified according to the heart rate quartile and blood pressure status for subgroups assessment. A total of 5,692 participants were enrolled in this study. After adjusting the confounding factors, there was a linear association between resting heart rate and microalbuminuria in patients with hypertension (OR 1.184 [per 1 SD]; 95% CI: 1.101, 1.274; P < 0.001). However, the association between elevated resting heart rate and microalbuminuria was not significant in patients with uncontrolled hypertension (OR 1.092 [per 1 SD]; 95% CI: 0.935, 1.275; P = 0.269). The OR of the indirect effect of β-blockers on the risk of microalbuminuria incidence through heart rate was 0.926 (95% CI: 0.895, 0.956), while the direct effect was 1.374 (95% CI: 1.138, 1.662, P = 0.010). Similarly, dihydropyridine calcium channel blockers were associated with a higher prevalence of microalbuminuria (OR 1.300, 95% CI: 1.058, 1.597, P = 0.013), but the association between non-dihydropyridine calcium channel blockers and microalbuminuria was not significant (OR 1.207, 95% CI: 0.737, 1.978, P = 0.454).ConclusionElevated resting heart rate is associated with a high risk of microalbuminuria in untreated patients and patients with controlled hypertension. Although there is a linear association between heart rate and microalbuminuria, the use of β-blockers exhibits a significantly increase in the prevalence of microalbuminuria in hypertension. Likewise, dihydropyridine calcium channel blockers may increase the risk of microalbuminuria in hypertension.

YI 2.4 Neural Baroreflex Sensitivity and Long-Term Effect of Antihypertensive Agents—A Pharmacological Substudy of the Paris Prospective Study III

Background/ObjectivesThe baroreflex is a crucial mechanism acutely modulating vascular tone and heart rate response to maintain blood pressure (BP) in an optimal range. A decrease in baroreflex sensitivity (BRS) is associated with ageing, and pathological conditions such as hypertension and diabetes. Antihypertensive agents are generally known to have beneficial effect on the BRS, however it is still uncertain if the effect is mediated through a more compliant arterial wall or a sympathoinhibitory action.MethodsIn the Paris Prospective Study III [1], spontaneous baroreflex, carotid stiffness and pharmacological drugs intake were available in 7967 adults (aged 55–75 years). The neural component of the baroreflex sensitivity (nBRS) was obtained with a cross-spectral analysis of variations in carotid distention rate and R-R intervals. Pharmacological classes were analysed according to the Anatomical Therapeutic Chemical (ATC) classification. Individuals with a BP lowering medication (BP-treated) were paired to non-BP treated individuals with a similar cardiovascular risk (controls) using a propensity score matching procedure (n = 1182 pairs).ResultsAmongst pharmacological classes of BP lowering agents, only agents acting on the renin-angiotensin system (ACEi-ARB) were associated with nBRS (β = −0.08, p = 0.045). Compared to their matched controls, ACEi-ARB users had lower nBRS (2.79 ± 0.66 vs. 2.90 ± 0.62, p = 0.03). In multivariate analysis, ACEi-ARB remained significant (stdβ = −0.09, p = 0.025) after adjustment for carotid stiffness (stdβ = 0.25, p < 0.001) and systolic pressure (stdβ = −0.20, p < 0.001).ConclusionIn this epidemiological study, ACEi-ARB were negatively associated with nBRS. This effect is independent of BP and stiffness, which may suggest an inhibition of sympathetic activity by ACEi-ARB.

Effect of Antihypertensive Agents on Biochemical Parameters in Diabetic Patients in Taif - KSA

Hypertension and diabetes mellitus are chronic medical conditions that frequently coexist. Our objective is to evaluate the effect of Angiotensin converting enzyme inhibitors and Angiotensin II receptor blockers comparatively and in integration with Metformin, dipeptidyl 4 inhibitors and insulin on lipid profile, serum creatinine, liver enzymes and electrolytes in type II diabetic patients.

Can propranolol prevent progression of melanoma?

The worldwide incidence of melanoma has risen rapidly in the past 50 years and is a considerable public health burden in the United States, with significant financial implications. Studies have demonstrated the potential anticarcinogenic effects of antihypertensive agents, specifically beta-blockers, in patients with prostate cancer, breast cancer, and lately cutaneous malignant melanoma. This article explores the empirical clinical evidence of propranolol's anticarcinogenic effects on melanoma and the chemoprotective mechanisms of beta-blockers and other agents that have been used to modify melanoma progression.

Effect of Antihypertensive Medications on Sepsis-Related Outcomes: A Population-Based Cohort Study.

Although the effect of antihypertensive agents on sepsis has been studied, evidence for survival benefit was limited in the literature. We investigated differences in sepsis-related outcomes depending on the antihypertensive drugs given prior to sepsis in patients with hypertension. Population-based cohort study. Sample cohort Database of the National Health Insurance Service from 2003 to 2013 in South Korea. Patients over 30 years old who were diagnosed with sepsis after receiving hypertension treatment. None. Primary outcomes, 30-day and 90-day mortality rates, were analyzed for differences among three representative antihypertensive medications: angiotensin- converting enzyme inhibitors or angiotensin II receptor blockers, calcium channel blockers, and thiazides. In total, 4,549 patients diagnosed with hypertension prior to hospitalization for sepsis were identified. The 30-day mortality was significantly higher among patients who did not receive any medications within 1 month before sepsis (36.8%) than among patients who did (32.0%; p < 0.001). The risk for 90-days mortality was significantly lower in prior angiotensin-converting enzyme inhibitors or angiotensin II receptor blocker users (reference) than in other drug users (odds ratio, 1.27; 95% CI, 1.07-1.52). There was no difference in the risk for 30-day and 90-day mortality depending on whether calcium channel blockers or thiazides were used. Use of calcium channel blockers was associated with a decreased risk for inotropic agent administration, compared with those of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (odds ratio, 1.23; 95% CI, 1.05-1.44) and thiazides (odds ratio, 1.33; 95% CI, 1.12-1.58). In patients with sepsis, lower mortality rate was associated with prior use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers not with use of calcium channel blockers or thiazides. The requirement of inotropic agents was significantly lower in prior use of calcium channel blockers, although the survival benefits were not prominent.

Abstract P362: Change of P Wave Parameters After Switching Anti-Hypertensive Agent From Free Drug Combination Into Fixed Dose Combination

Background: In hypertensive patients, it is well-known that PWD (P wave dispersion = maximal P wave duration - minimal P wave duration) is associated with the level of BP and the level of PWD correlates with the prevalence of arrhythmias and left atrial enlargement in previous studies. Fixed-dose combination(FDC) of anti-hypertensive agents effectively lower BP compared with free-drug combination. There have been some studies comparing the effect of anti-hypertensive agents on P-wave parameters. However, there have been no studies assessing the change of PWD after switching anti-hypertensive agents from free drug combination into fixed-dose combination Objective: The aim of this study was to assess the change of PWD after switching anti-hypertensive agents from free drug combination of angiotensin II receptor blocker(ARB)/Calcium channel blocker(CCB) into fixed-dose combination Design and Method: This study included 20 patients who changed anti-hypertensive agents from free drug combination of ARB/CCB into same dosage fixed-dose combinations (FDCs) of ARB/CCB during 2011 to 2014. The maximal P wave duration(maxPWD), minimal P wave duration(minPWD), P wave dispersion(PWD), cPWD(corrected by heart rate, i.e. corrected P wave dispersion) measured by 12-lead electrocardiogram(ECG) at a paper speed of 50mm/s and 20mm/mV Results: The PWD was reduced non-statically after changed into fixed dose combination (54.45±13.14ms) compared with free drug combination (56.73±11.90ms, p=0.070). The cPWD was reduced statically after changed into fixed dose combination (56.72±11.90ms) compared with free drug combination (60.02±12.28ms, p=0.003). Conclusions: The cPWD significantly reduced after switching anti-hypertensive agents from free drug combination into fixed dose combination

Gender Differences in Epidemiology, Pathophysiology, and Treatment of Hypertension.

This review aims to examine gender differences in both the epidemiology and pathophysiology of hypertension and to explore gender peculiarities on the effects of antihypertensive agents in decreasing BP and CV events. Men and women differ in prevalence, awareness, and control rate of hypertension in an age-dependent manner. Studies suggest that sex hormones changes play a pivotal role in the pathophysiology of hypertension in postmenopausal women. Estrogens influence the vascular system inducing vasodilatation, inhibiting vascular remodeling processes, and modulating the renin-angiotensin aldosterone system and the sympathetic system. This leads to a protective effect on arterial stiffness during reproductive age that is dramatically reversed after menopause. Data on the efficacy of antihypertensive therapy between genders are conflicting, and the underrepresentation of aged women in large clinical trials could influence the results. Therefore, further clinical research is needed to uncover potential gender differences in hypertension to promote the development of a gender-oriented approach to antihypertensive treatment.

Effect of antihypertensive agents ACEI/ARB and CCB on hypertensive intracerebral hemorrhage and inflammatory cytokines, serum ferritin, and serum P

The aim of this study was to investigate the effect of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) and calcium channel blocker (CCB) antihypertensive drugs on the treatment of hypertensive intracerebral hemorrhage (ICH) and on the expression level of inflammatory factors, serum ferritin (SF), and serum substance P (SP). A total of 160 patients with hypertensive ICH were divided into three groups according to the type of antihypertensive drugs taken before cerebral hemorrhage: group A (40 cases, taking ACEI/ARB antihypertensive drugs before cerebral hemorrhage), group B (40 cases, CCB antihypertensive drugs were regularly taken before the onset of cerebral hemorrhage), and C group (80 cases, nor any antihypertensive drugs were regularly taken before the onset of cerebral hemorrhage). Patients in group C were further divided into two groups: group D (40 cases, ARB antihypertensive drugs were regularly taken after cerebral hemorrhage) and group E (40 cases, CCB antihypertensive drugs were regularly taken after cerebral hemorrhage). On the third day, after the onset of disease, the level of serum interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, SF, and SP in all the patients was detected. At the same time, the brain computed tomography (CT) was used to evaluate the cerebral edema. On the first day and the thirty day after the onset of disease, the patient’s neurological deficit status was assessed according to the National Institutes of Health Stroke Scale (NIHSS) score. On the third day after onset, the levels of IL-1β, IL-6, TNF-α, SF, and the volume of cerebral edema in group A and group B were significantly lower than those in group C ( P &lt; 0.05). The level of serum SP in group A and group B was significantly higher than that in group C ( P &lt; 0.05). However, there was no significant difference between group A and group B ( P &gt; 0.05). On the third day after onset, the mortality of each group is of no significant difference ( P &gt; 0.05). However, NIHSS scores in group A and group B were significantly lower than those in group C ( P &lt; 0.05). There was no statistical difference in NIHSS scores between group A and group B ( P &gt; 0.05). In conclusion, in the early stage of hypertensive ICH, early normative use of ACEI/ARB or CCB antihypertensive drugs can improve the prognosis of patients, whose mechanism may be related to the improvement of level of serum inflammatory factors and SP and SF.

Effects of Antihypertensive Agents on Intestinal Contractility in the Spontaneously Hypertensive Rat: Angiotensin Receptor System Downregulation by Losartan.

Hypertension is an inflammatory condition controlled by the renin angiotensin system and is linked to kidney disease, diabetes mellitus, and recently to dysfunction of the gut. The aim of this study was to determine what effect antihypertensive drug treatments may have on intestinal function of the spontaneously hypertensive rat (SHR). In the first experiment, SHRs were treated with enalapril, hydralazine, or with no treatment as a control. In the second experiment, SHRs were treated with losartan or with no treatment as a control. All drug treatments led to significant lowering of blood pressure after 16 weeks. At termination, intact tissue sections of the ileum and colon were induced to contract ex vivo by KCl; electrical stimulation; and agonists carbachol, angiotensin II, and prostaglandin E2 (PGE2). There were no differences in ileal or colonic contractility due to hydralazine or enalapril compared with no-treatment SHR control. However, for the ileum, the losartan group responded significantly more to KCl and carbachol while responding less to angiotensin II, with no difference for PGE2 compared with the no-treatment SHR control. In contrast, the colon responded similarly to KCl, electrical stimulation, and PGE2 but responded significantly less to angiotensin II. These results demonstrate that the ileum responds differently (with KCl and carbachol as agonists) to the colon after losartan treatment, whereas there is a reduced contractile response in both the ileum and colon following losartan treatment. Although there are few well documented major contraindications for angiotensin receptor blockers, the modulation of gut contractility by losartan may have wider implications for bowel health.

Providing Innovative Solutions in a Single Pill: Servier’s Portfolio in Hypertension

Jean-Jacques Mourad & Jean-Christophe Guillerm speak to Henry Ireland, Drug Evaluation Editor: Jean-Jacques Mourad talks about his vision of the current landscape and unmet medical needs in the field of hypertension. Jean-Christophe Guillerm describes the family of antihypertensive treatments from Servier, which were designed to address the current challenges in the management of hypertension by providing an adapted solution to doctors and to the specific needs of each patient. Jean-Jacques Mourad currently works as Professor of Medicine and is the Head of the Hypertension Unit at the Hôpital Avicenne in Bobigny, France. He completed his academic degrees at the Pierre and Marie Curie University, Paris VI in the field of internal and vascular medicine in 1996, and in the area of cardiovascular medicine and pharmacology in 2001. He is the past president of the French League Against Hypertension (since 2012), and the former General Secretary of the French Microcirculation Society. He is the actual Scientific Secretary of the French Society of Hypertension. He is also a member of the administrative council of the Collège Français de Pathologie Vasculaire. His research focuses on the epidemiology of hypertension, arterial structure and function, determinants of adherence to chronic treatment and the effects of antihypertensive agents. He was involved in several studies and surveys. He is a co-author of more than 130 publications and of 900 communications presented at national and international meetings. Jean-Christophe Guillerm, joined the pharmaceutical industry 17 years ago. He is currently the Head of the Cardiovascular Division for Servier, in charge of both cardiology and hypertension's medical strategy at a global level. Prior to this, he was in charge of the diabetes and internal medicine franchise at a global level. He also has experience in French commercial operations.

To study the comparative effects of nebivolol and metoprolol on lipid profile in patients of essential hypertension

Background: Hypertension and certain alteration in serum lipoproteins are complementary coronary risk factors. The effect of antihypertensive agents on lipid metabolism exhibits a wide range. Numerous studies have established that vasodilating beta-blockers are associated with more favorable effects on glucose and lipid profiles than non-vasodilating beta-blockers. The study was conducted to study the comparative effects of nebivolol and metoprolol on lipid profile in patients of essential hypertension. Methods: A prospective, randomized open label single center study was conducted in the Department of Pharmacology in collaboration with Department of Medicine, MGM’s Medical College and Hospital, Aurangabad in newly diagnosed patients of essential hypertension. Sixty patients of either sex in the age group of 30-65 years with blood pressure (BP) of ≥140/90 mmHg with deranged lipid parameters according to National Cholesterol Education Program were randomized into two groups. Group I received metoprolol (50 mg) and Group II received nebivolol (5 mg), both given once daily for 12 weeks. BP and lipid parameters were evaluated at baseline as well as at the end of 12 weeks. Results: There was significant reduction in BP values (p<0.0001) as compared to baseline in both the groups, however no significant difference was observed between two drugs revealing that their efficacy in reducing systolic BP/diastolic BP is comparable. Furthermore, both the drugs had a favorable effect on lipid profile, but more significant results on lipid profile were observed in the nebivolol group as compared to metoprolol group (p<0.0001). Conclusions: In our comparison study, it is seen that the favorable effect of nebivolol on serum lipids and its good tolerability profile make it a good choice for control of hypertension as well as preventing the long-term cardiovascular morbidities and mortalities.

The effect of antihypertensive agents on sleep apnea: protocol for a randomized controlled trial

BackgroundObstructive sleep apnea (OSA) and hypertension are well-known cardiovascular risk factors. Their control could reduce the burden of heart disease across populations. Several drugs are used to control hypertension, but the only consistently effective treatment of OSA is continuous positive airway pressure. The identification of a drug capable of improving OSA and hypertension simultaneously would provide a novel approach in the treatment of both diseases.Methods/DesignThis is a randomized double-blind clinical trial, comparing the use of chlorthalidone with amiloride versus amlodipine as a first drug option in patients older than 40 years of age with stage I hypertension (140 to 159/90 to 99 mmHg) and moderate OSA (15 to 30 apneas/hour of sleep). The primary outcomes are the variation of the number of apneas per hour and blood pressure measured by ambulatory blood pressure monitoring. The secondary outcomes are adverse events, somnolence scale (Epworth), ventilatory parameters and C reactive protein levels. The follow-up will last 8 weeks. There will be 29 participants per group. The project has been approved by the ethics committee of our institution.DiscussionThe role of fluid retention in OSA has been known for several decades. The use of diuretics are well established in treating hypertension but have never been appropriately tested for sleep apnea. As well as testing the efficacy of these drugs, this study will help to understand the mechanisms that link hypertension and sleep apnea and their treatment.Trial registrationClinicalTrials.gov: NCT01896661

Gender Differences in Hypertension: Myths and Reality

Life expectancy is longer in women compared to men, and cardiovascular events occur at a lower rate and at a later age in females than males. The impact of gender on the prevalence, the presentation, and the long-term outcome of cardiovascular disease has long been a topic of active research. Gender differences have been found in several studies but opposite findings also exist. The impact of gender in hypertension and antihypertensive therapy remains poorly clarified. The prevalence, awareness, treatment, and control rates of hypertension exhibit some differences between the two sexes, which are age-dependent. The female advantage in the cardiovascular risk of hypertensive patients might be attenuated by comorbidities and target organ damage. Another aspect of major clinical importance is whether gender differences exist on the effects of antihypertensive agents in blood pressure reduction and cardiovascular morbidity and mortality. The aim of this review is to critically evaluate recent data regarding gender differences in hypertension and incorporate new data into the body of existing knowledge.