Impact Of Antihypertensive Drugs Research Articles

Steroidomics-Based Screening for Primary Aldosteronism: Impact of antihypertensive Drugs.

Diagnosis of primary aldosteronism (PA) is complicated by the need to withdraw antihypertensive medications that interfere with test results, particularly renin. This study examined whether machine learning-based steroid-probability scores offer a renin measurement-independent approach for testing less prone to interference than the aldosterone-to-renin ratio (ARR). This prospective multicenter cohort study involved the use of plasma steroidomics and the ARR in 839 patients tested for PA, including 190 with and 578 without PA (71 indeterminate). Receiver operating characteristic curves for steroid-probability scores and the ARR were examined with and without interfering medications. Impacts of individual medications on plasma aldosterone, 18-oxocortisol, 18-hydroxycortisol, steroid-probability scores, renin, and ARRs were examined by multivariable and paired analyses in patients with and without PA. Receiver operating characteristic curves indicated a significant impact of interfering antihypertensive medications on the diagnostic performance of the ARR and minimal impact on steroid-probability scores. Mineralocorticoid receptor antagonists increased plasma aldosterone, 18-oxocortisol, and 18-hydroxycortisol in patients without PA and resulted in false-positive test results for steroid-probability scores and false-negative results for the ARR. Diuretics increased aldosterone, 18-oxocortisol, and steroid-probability scores in patients without PA, whereas angiotensin-converting enzyme inhibitors decreased aldosterone, steroid-probability scores, and ARRs. Beta-adrenoceptor blockers, dihydropyridine calcium channel blockers, and angiotensin receptor blockers had negligible impact on mineralocorticoids and steroid-probability scores. Among antihypertensive drugs that impact plasma aldosterone, 18-oxocortisol, and 18-hydroxycortisol, mineralocorticoid receptor antagonists stood out as a cause of false-positive results for derived steroid-probability scores. Other antihypertensives have minimal or no impact, an advantage for use of steroid-probability scores over the ARR when those medications cannot be withdrawn. URL: https://drks.de/; Unique identifier: DRKS00017084.

Spécificités du traitement médicamenteux antihypertenseur chez la femme

The impact of antihypertensive drugs on blood pressure does not differ according to the sex. There are women-specific conditions or medical conditions encountered more frequently among womens that guide the selection of therapy such as a desire to become pregnant, a pregnancy, a polycystic ovarian syndrome, breast cancer, osteoporosis or migraine.

IMPROVING HYPERTENSION CONTROL BY MOLECULAR STRATIFICATION OF FIRST-LINE NON-RESPONDERS USING RAAS TRIPLE-A TESTING

Objective: According to new European guidelines, first-line anti-hypertensive therapies include either an ACE inhibitor (ACEi) or an angiotensin receptor blocker (ARB) in a single pill combination with a calcium channel blocker (CCB) or a diuretic. Insufficient therapeutic effects could be caused by various factors ranging from compliance issues, patient specific PK/PD profiles, or secondary forms of hypertension. Altogether these factors contribute to blood pressure control rates ranging around 50% of patients on antihypertensive treatment. Design and method: RAAS Triple-A testing is based on a clinical high-throughput mass-spectrometry assay for simultaneous quantification of Angiotensin-I (Ang-I), Angiotenisn-II (Ang-II) and Aldosterone in standard serum or plasma samples by RAAS equilibrium analysis. Equilibrium angiotensin (eqAng-I, eqAng-II) and aldosterone levels are used to calculate markers for plasma-renin-activity (PRA-S), plasma angiotensin-converting-enzyme activity (ACE-S) and adrenal function (AA2-Ratio) that have been validated in healthy volunteers and hypertensive patients on therapy. The diagnostic performance of the AA2-Ratio in screening for primary aldosteronism (PA) has been compared to the aldosterone-to-renin ratio (ARR) as putative gold standard in resistant hypertensive patients, revealing major advantages of the AA2-Ratio especially in terms of usability and drug interference. Results: A diagnostic scheme for the stratification of first-line non-responding hypertensive patients has been developed to improve the control rates for hypertension and to provide an easy-to-handle diagnostic tool for physicians involved in first-line treatment of hypertension. The complex functional relations and the impact of anti-hypertensive drugs on selected angiotensin derived biomarkers are combined into a diagnostic scheme that allows for easy evaluation of compliance and dosing efficiency while effectively screening for major forms of secondary hypertension including PA, potentially without the need of withdrawing ACE inhibitors before screening. Conclusions: The RAAS Triple-A analysis for the first time provides insights into a patient's RAAS at the level of effector hormones, molecular regulation and patient specific pharmacologic responses to anti-hypertensive therapies. RAAS Triple-A testing allows for simultaneous diagnostic assessment of multiple causes for uncontrolled hypertension and has the potential to result in significant changes in hypertension care in clinical practice by introducing personalized treatments based on an easy and effective diagnostic tool.

Impact of anti-hypertensive drugs on aortic stiffness induced by chronic kidney disease and mineral bone disorder in rats

BackgroundIn chronic kidney disease (CKD), anomalies of mineral bone disorder (MBD) play a central role in vascular calcification and increased aortic stiffness. The impact of antihypertensive drugs on MBD-induced vascular calcification remains uncertain. The aim of this study was to examine whether endothelin A receptor antagonist (ETAA), angiotensin type-1 receptor antagonist (AT1A) and the combination of hydralazine/hydrochlorothiazide (HDZ/HCT) can reduce vascular stiffness in a rat model of CKD-MBD.MethodUsing a remnant kidney model of CKD in rats, vascular calcification was induced by creating MBD through high a calcium-phosphate diet and vitamin D supplementation. Three antihypertensive treatments were investigated: atrasentan (ETA blocker), losartan (AT1 blocker) and HDZ/HCT. Blood pressures (BPs) were measured invasively after (6 weeks) and aortic stiffness was determined by the assessment of pulse wave velocity (PWV).ResultsPWV and mean BP increased in rats with CKD-MBD as compared to CKD (640 ± 130 vs. 390 ± 34 cm/s and 100 ± 17 vs. 92 ± 21 mmHg; p p < 0.05). Treatment of CKD-MBD rats with ETAA and AT1A, but not HDZ/ HCT, reduced PWV (517 ± 94, 596 ± 134 and 761 ± 116 cm/s respectively) despite similar reduction of mean BP by the different treatments (73 ± 16, 75 ± 19 and 70 ± 20 mmHg, respectively). Creatinine clearance and mineral metabolism parameters were relatively similar among groups.ConclusionMBD-induced aortic stiffness in CKD rats was improved by atrasentan and losartan, but not the combination of HDZ/HCT, indicating blood pressure-independent protective effects of ETAA and AT1A.

Effect of blood pressure normalization (reaching the target level) on epinephrine-induced platelet aggregation changes in patients with hypertension

There is a little data about the impact of blood pressure normalization on platelet aggregation properties and the impact of antihypertensive drugs on platelet hemostasis. Aim. To study adrenaline-induced platelet aggregation changes in patients with hypertension achieving target blood pressure under the influence of antihypertensive therapy. Material and Methods. The study involved 149 patients with stage II, second degree EH, who were divided into 2 groups based on target levels of blood pressure. The first group included 48 patients with essential hypertension who achieved target levels of blood pressure, the second group - 101 patients with EH, who have not reached the target blood pressure. Groups of patients were comparable in age. All patients were performed by DMAP and LTA. Results. Groups EH patients who achieved and did not achieve the target blood pressure were comparable by the types of aggregations. The percentage of two-phase aggregation was 19% of the first group patients and 22% of the second group patients (p = 0.675), drain 16% and 13% (p = 0.622) respectively, oppressed 48% and 56% (p = 0,362) respectively, missing 17% and 9% (p = 0.156), respectively. Patients with essential hypertension who have not reached the target level of blood pressure had the two-phase curve adrenaline-induced platelet aggregation 36.4% (p = 0.001) greater than the maximum degree of aggregation within 5 minutes of recording, 14.8% (p = 0.009) greater than the maximum degree of aggregation within 10 minutes of recording, 28.3% (p = 0.023) greater degree of aggregation on the third minute, 34.3% (p = 0.002) greater degree of aggregation on the fifth minute, 28 0% (p = 0.009) greater area under the curve of aggregation on the fifth minute, and 21.4% (p = 0.005) on the ten minute than similar rates in patients with EH, who have achieved the target blood pressure. Conclusions. Achieving target blood pressure in patients with hypertension is accompanied by multidirectional changes of platelets aggregation properties. Normalization of blood pressure in patients with hypertension in 36% of cases is associated with reduced epinephrine-induced platelet aggregation.

Effect of antihypertensive therapy on hospitalization and mortality among uncomplicated and high risk hypertensive patients

Objective: Evaluate the impact of antihypertensive drugs (AHD) on stroke and acute myocardial infarction (AMI) and death for 3 cohorts of patients: diabetics, high risk, and hypertensive. Methods: This was a retrospective cohort obervational study based on administrative database of 7 Italian Local Health Units. Newly treated patients with AHD were enrolled from 01/01/2004 to 06/30/2007. Drug utilization and incidence of death, stroke and AMI were measured until 12/31/2007. Results: The study enrolled 125,770 patients aged ≥ 18-year-old: 8516 diabetic, 8549 high risk, and 108,705 hypertensive. Diabetic and high risk patients were more frequently male (57.2%, 64.9% VS 46.6%) and older (66.4 ± 11.6, 67.5 ± 13.2 VS 61.6 ± 13.9) than hypertensive patients and were more treated with concomitant therapy. Drugs acting on the renin-angiotensin system were the more fre- quent choice in the three cohorts but with a dif- ferent prevalence (63.9%, 52.9%, 35.9% in dia- betic, hypertensive and high risk patients re- spectively). Adherent patients to AHD > 80% were 44.0% among diabetic patients, 48.4% among high risk, 35.2% among hypertensive. A Cox regression model showed that the risk of the combined outcome was determined by increasing age, male gender, presence of concomitant therapy, low adherence to AHD and first choice of AHD. Conclusions: An integrated analysis of prescription and hospital admission database has the great advantage that it uses routinely available data, it can be done quickly and by few staff, and it is less expensive than planned large scale survey.

Impact of antihypertensive drugs on TNF-like weak inducer of apoptosis

Impact of antihypertensive drugs on TNF-like weak inducer of apoptosis

P2-300 Effects of antihypertensive drug treatments on bone turnover in elderly men: a cross-sectional analysis of the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) study

IntroductionPrevious studies have found that some antihypertensive drugs may lower fracture risk. However, the impact of antihypertensive drugs on bone metabolism is not entirely clear. We examined how antihypertensive drugs...

The Effect of Antihypertensive Agents on Insulin Sensitivity, Lipids and Haemostasis

Antihypertensive agents exert different effects on insulin sensitivity, lipids and haemostasis. However, most studies assessing these effects were small and short-term yielding conflicting results. Moreover, it has not been established whether the impact of antihypertensive drugs on insulin sensitivity, lipids, thrombosis and fibrinolysis adds to or attenuates vascular risk reduction. On the other hand, new onset type 2 diabetes mellitus (T2DM) appears to be more frequent in patients treated with β-blockers and diuretics, whereas angiotensin converting enzyme inhibitors and angiotensin receptor blockers might reduce the risk for T2DM and calcium channel blockers have a neutral effect. Therefore, the risk of developing T2DM should be considered when selecting an antihypertensive agent. This review discusses the differential effects of antihypertensive drugs on insulin sensitivity, lipids and haemostasis and considers their association with vascular risk.

Association between resting heart rate and hypertension treatment in a general population

Epidemiologic studies have reported a relationship between resting heart rate (RHR) and cardiovascular mortality, particularly in hypertensive subjects. In a representative sample (n = 1175) of women and men aged 35 to 64 years, we studied the associations between RHR and hypertension. RHR was associated with sex ( P < .001), socioeconomic and marital status ( P < .05), physical fitness ( P < .001), smoking ( P < .05), hypercholesterolemia ( P < .01), body mass index ( P < .01), blood pressure ( P < .01), triglyceride levels ( P < .01), glycemia ( P < .05), hematocrit ( P < .001 in men, not significant in women), and white blood cell count ( P < .01). Logistic regression models adjusted for the above variables were developed with RHR coded as a polytomous outcome variable (RHR <65/min; 65 ≤ RHR <75/min; 75 ≤ RHR <85/min; RHR ≥85/min). Subjects unaware of their hypertension had significant adjusted odds ratios for high RHR categories [75 ≤ RHR <85/min: 2.11 (1.37 to 3.23), P < .001; RHR ≥85/min: 4.71 (2.06 to 10.78), P < .001]. People treated for hypertension had nonsignificant odds ratios whatever the RHR categories. After adjustment for numerous risk factors, elevated RHR were associated with high blood pressure in unaware hypertensive subjects. The impact of antihypertensive drugs with different RHR lowering effects remains to be studied on a population basis.

Impact of antihypertensive drugs on the cardiovascular patient

The impact of antihypertensive drugs has been considerable over the last few decades. Hypertension-associated mortality and morbidity have decreased significantly following the introduction of potent and useful antihypertensive drugs. Against this background, it is disturbing that three recent large-scale studies have shown that morbidity and mortality in treated hypertensive patients are markedly higher than in comparable normotensive subjects. It is conceivable that these findings can be explained to some extent by the fact that the elevated arterial pressure quite frequently is not lowered to strictly normotensive levels. Another aspect of the impact of antihypertensive drugs is that they frequently affect the mood and well-being of the patient. In the early days of antihypertensive therapy, the interference of drugs with the quality of life was considerable. With the drugs available today, negative effects on well-being are much rarer, although still extant. Thus, there is still room for improvement of antihypertensive drugs both in this respect and, more importantly, in achieving a further lowering of hypertension-induced cardiovascular morbidity and mortality.