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1.
Chem Biol ; 15(11): 1231-40, 2008 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-19022183

RESUMO

When an enoylreductase enzyme of a modular polyketide synthase reduces a propionate extender unit that has been newly added to the growing polyketide chain, the resulting methyl branch may have either S or R configuration. We have uncovered a correlation between the presence or absence of a unique tyrosine residue in the ER active site and the chirality of the methyl branch that is introduced. When this position in the active site is occupied by a tyrosine residue, the methyl branch has S configuration, otherwise it has R configuration. In a model PKS in vivo, a mutation (Tyr to Val) in an erythromycin PKS-derived ER caused a switch in the methyl branch configuration in the product from S to R. In contrast, alteration (Val to Tyr) at this position in a rapamycin-derived PKS ER was insufficient to achieve a switch from R to S, showing that additional residues also participate in stereocontrol of enoylreduction.


Assuntos
Oxirredutases atuantes sobre Doadores de Grupo CH-CH/química , Oxirredutases atuantes sobre Doadores de Grupo CH-CH/genética , Policetídeo Sintases/química , Policetídeo Sintases/genética , Engenharia de Proteínas/métodos , Saccharopolyspora/enzimologia , Sequência de Aminoácidos , Domínio Catalítico , Parede Celular/metabolismo , Ácidos Graxos/metabolismo , Dados de Sequência Molecular , Mutagênese Sítio-Dirigida , Mycobacterium/citologia , Oxirredutases atuantes sobre Doadores de Grupo CH-CH/metabolismo , Policetídeo Sintases/metabolismo , Propionatos/metabolismo , Estrutura Terciária de Proteína , Alinhamento de Sequência , Homologia de Sequência de Aminoácidos , Estereoisomerismo
2.
Org Biomol Chem ; 6(18): 3315-27, 2008 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-18802638

RESUMO

The glycosylation of natural product scaffolds with highly modified deoxysugars is often essential for their biological activity, being responsible for specific contacts to molecular targets and significantly affecting their pharmacokinetic properties. In order to provide tools for the targeted alteration of natural product glycosylation patterns, significant strides have been made to understand the biosynthesis of activated deoxysugars and their transfer. We report here efforts towards the production of plasmid-borne biosynthetic gene cassettes capable of producing TDP-activated forms of D-mycaminose, D-angolosamine and D-desosamine. We additionally describe the transfer of these deoxysugars to macrolide aglycones using the glycosyl transferases EryCIII, TylMII and AngMII, which display usefully broad substrate tolerance.


Assuntos
Glucosamina/análogos & derivados , Macrolídeos/química , Macrolídeos/metabolismo , Clonagem Molecular , Engenharia Genética , Glucosamina/química , Glucosamina/metabolismo , Estrutura Molecular , Família Multigênica/genética , Análise de Sequência , Streptomyces/química , Streptomyces/genética , Streptomyces/metabolismo
3.
Chem Biol ; 14(6): 703-14, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17584617

RESUMO

Nigericin was among the first polyether ionophores to be discovered, but its biosynthesis remains obscure. The biosynthetic gene cluster for nigericin has been serendipitously cloned from Streptomyces sp. DSM4137, and deletion of this gene cluster abolished the production of both nigericin and the closely related metabolite abierixin. Detailed comparison of the nigericin biosynthetic genes with their counterparts in the biosynthetic clusters for other polyketides has prompted a significant revision of the proposed common pathway for polyether biosynthesis. In particular, we present evidence that in nigericin, nanchangmycin, and monensin, an unusual ketosynthase-like protein, KSX, transfers the initially formed linear polyketide chain to a discrete acyl carrier protein, ACPX, for oxidative cyclization. Consistent with this, deletion of either monACPX or monKSX from the monensin gene cluster effectively abolished monensin A biosynthesis.


Assuntos
Antibacterianos/biossíntese , Família Multigênica/genética , Nigericina/biossíntese , Streptomyces/metabolismo , Acilação , Sequência de Aminoácidos , Antibacterianos/química , Clonagem Molecular , Ciclização , Escherichia coli/genética , Deleção de Genes , Genes Bacterianos , Dados de Sequência Molecular , Nigericina/química , Fases de Leitura Aberta , Oxirredução , Policetídeo Sintases/genética , Policetídeo Sintases/metabolismo , Alinhamento de Sequência , Streptomyces/enzimologia , Streptomyces/genética
4.
Nat Biotechnol ; 25(4): 447-53, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17369815

RESUMO

Saccharopolyspora erythraea is used for the industrial-scale production of the antibiotic erythromycin A, derivatives of which play a vital role in medicine. The sequenced chromosome of this soil bacterium comprises 8,212,805 base pairs, predicted to encode 7,264 genes. It is circular, like those of the pathogenic actinomycetes Mycobacterium tuberculosis and Corynebacterium diphtheriae, but unlike the linear chromosomes of the model actinomycete Streptomyces coelicolor A3(2) and the closely related Streptomyces avermitilis. The S. erythraea genome contains at least 25 gene clusters for production of known or predicted secondary metabolites, at least 72 genes predicted to confer resistance to a range of common antibiotic classes and many sets of duplicated genes to support its saprophytic lifestyle. The availability of the genome sequence of S. erythraea will improve insight into its biology and facilitate rational development of strains to generate high-titer producers of clinically important antibiotics.


Assuntos
Eritromicina/biossíntese , Genoma Bacteriano , Saccharopolyspora/genética , Análise de Sequência de DNA , Cromossomos Bacterianos/genética , Resistência Microbiana a Medicamentos , Genes Bacterianos , Dados de Sequência Molecular , Streptomyces coelicolor/genética
5.
Acute Med ; 6(3): 121-3, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-21611586

RESUMO

The admission of older patients with acute medical problems to short stay medical units (SSMUs) is controversial in light of their longer expected length of in-patient stay (LoS), coupled with the greater resources required by such a department. We undertook a prospective study of 120 consecutive SSMU patients aged 60 years or over, to find out whether information gained during the admissions process could predict which candidates would subsequently have a successful SSMU outcome, as well as to assess the overall suitability of the SSMU to older patients. Our redesigned acute medicine services at Addenbrooker's Hospital (Cambridge, UK) have taken account of our results, and we continue to admit older patients to our new Medical Short Stay Emergency Unit.

6.
Microbiology (Reading) ; 152(Pt 12): 3507-3515, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17159202

RESUMO

Meridamycin is a non-immunosuppressant, FKBP-binding macrocyclic polyketide, which has major potential as a neuroprotectant in a range of neurodegenerative disorders including dementia, Parkinson's disease and ischaemic stroke. A biosynthetic cluster predicted to encode biosynthesis of meridamycin was cloned from the prolific secondary-metabolite-producing strain Streptomyces sp. DSM 4137, not previously known to produce this compound, and specific gene deletion was used to confirm the role of this cluster in the biosynthesis of meridamycin. The meridamycin modular polyketide synthase consists of 14 extension modules distributed between three giant multienzyme proteins. The terminal module is flanked by a highly unusual cytochrome P450-like domain. The characterization of the meridamycin biosynthetic locus in this readily manipulated streptomycete species opens the way to the engineering of new, altered meridamycins of potential therapeutic importance.


Assuntos
Proteínas de Bactérias/genética , Genes Bacterianos , Macrolídeos/metabolismo , Fármacos Neuroprotetores/metabolismo , Policetídeo Sintases/genética , Streptomyces/genética , Proteínas de Bactérias/fisiologia , Clonagem Molecular , Sistema Enzimático do Citocromo P-450/genética , DNA Bacteriano/química , DNA Bacteriano/genética , Enzimas/genética , Enzimas/fisiologia , Deleção de Genes , Macrolídeos/farmacologia , Dados de Sequência Molecular , Família Multigênica , Fármacos Neuroprotetores/farmacologia , Estrutura Terciária de Proteína , Análise de Sequência de DNA , Streptomyces/metabolismo
7.
Chem Biol ; 13(5): 475-84, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16720268

RESUMO

A genomic library of Streptomyces cattleya was screened to isolate a gene cluster encoding enzymes responsible for the production of fluorine-containing metabolites. In addition to the previously described fluorinase FlA which catalyzes the formation of 5'-fluoro-5'-deoxyadenosine from S-adenosylmethionine and fluoride, 11 other putative open reading frames have been identified. Three of the proteins encoded by these genes have been characterized. FlB was determined to be the second enzyme in the pathway, catalyzing the phosphorolytic cleavage of 5'-fluoro-5'-deoxyadenosine to produce 5-fluoro-5-deoxy-D-ribose-1-phosphate. The enzyme FlI was found to be an S-adenosylhomocysteine hydrolase, which may act to relieve S-adenosylhomocysteine inhibition of the fluorinase. Finally, flK encodes a thioesterase which catalyzes the selective breakdown of fluoroacetyl-CoA but not acetyl-CoA, suggesting that it provides the producing strain with a mechanism for resistance to fluoroacetate.


Assuntos
Acetilcoenzima A/metabolismo , Esterases/metabolismo , Compostos de Flúor/metabolismo , Família Multigênica , Streptomyces/genética , Sequência de Aminoácidos , Sequência de Bases , Catálise , Primers do DNA , Esterases/genética , Genes Bacterianos , Dados de Sequência Molecular , Fases de Leitura Aberta , Homologia de Sequência de Aminoácidos , Streptomyces/enzimologia , Streptomyces/metabolismo
8.
Microbiology (Reading) ; 151(Pt 10): 3161-3169, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16207901

RESUMO

The macrolide antibiotic concanamycin A has been identified as an exceptionally potent inhibitor of the vacuolar (V-type) ATPase. Such compounds have been mooted as the basis of a potential drug treatment for osteoporosis, since the V-ATPase is involved in the osteoclast-mediated bone resorption that underlies this common condition. To enable combinatorial engineering of altered concanamycins, the biosynthetic gene cluster governing the biosynthesis of concanamycin A has been cloned from Streptomyces neyagawaensis and shown to span a region of over 100 kbp of contiguous DNA. An efficient transformation system has been developed for S. neyagawaensis and used to demonstrate the role of the cloned locus in the formation of concanamycin A. Sequence analysis of the 28 ORFs in the region has revealed key features of the biosynthetic pathway, in particular the biosynthetic origin of portions of the backbone, which arise from the unusual polyketide building blocks ethylmalonyl-CoA and methoxymalonyl-ACP, and the origin of the pendant deoxysugar moiety 4'-O-carbamoyl-2'-deoxyrhamnose, as well as the presence of a modular polyketide synthase (PKS) encoded by six giant ORFs. Examination of the methoxymalonyl-specific acyltransferase (AT) domains has led to recognition of an amino acid sequence motif which can be used to distinguish methylmalonyl-CoA- from methoxymalonyl-ACP-specific AT domains in natural PKSs.


Assuntos
Inibidores Enzimáticos/metabolismo , Genes Bacterianos , Macrolídeos/metabolismo , Streptomyces/genética , Proteína de Transporte de Acila/química , Proteína de Transporte de Acila/genética , Proteína de Transporte de Acila/metabolismo , Sequência de Aminoácidos , Proteínas de Bactérias/química , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Clonagem Molecular , Inibidores Enzimáticos/química , Regulação Bacteriana da Expressão Gênica , Macrolídeos/química , Dados de Sequência Molecular , Família Multigênica , Policetídeo Sintases/química , Policetídeo Sintases/genética , Policetídeo Sintases/metabolismo , Análise de Sequência de DNA , Streptomyces/metabolismo
9.
Org Biomol Chem ; 3(8): 1410-8, 2005 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-15827636

RESUMO

The biosynthetic gene cluster of the 2-deoxystreptamine (DOS)-containing aminoglycoside antibiotic neomycin has been cloned for the first time by screening of a cosmid library of Streptomyces fradiae NCIMB 8233. Sequence analysis has identified 21 putative open reading frames (ORFs) in the neomycin gene cluster (neo) with significant protein sequence similarity to gene products involved in the biosynthesis of other DOS-containing aminoglycosides, namely butirosin (btr), gentamycin (gnt), tobramycin (tbm) and kanamycin (kan). Located at the 5'-end of the neo gene cluster is the previously-characterised neomycin phosphotransferase gene (apH). Three genes unique to the neo and btr clusters have been revealed by comparison of the neo cluster to btr, gnt, tbm and kan clusters. This suggests that these three genes may be involved in the transfer of a ribose moiety to the DOS ring during the antibiotic biosynthesis. The product of the neo-6 gene is characterised here as the L-glutamine : 2-deoxy-scyllo-inosose aminotransferase responsible for the first transamination in DOS biosynthesis, which supports the assignment of the gene cluster.


Assuntos
Família Multigênica/genética , Neomicina/biossíntese , Streptomyces/enzimologia , Streptomyces/genética , Transaminases/química , Aminação , Configuração de Carboidratos , Cromatografia Líquida , Clonagem Molecular , Hexosaminas/biossíntese , Fases de Leitura Aberta/genética , Ribose/química , Análise Espectral , Streptomyces/classificação
10.
Br J Pharmacol ; 143(4): 465-76, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15381636

RESUMO

1. Adenylyl cyclase VI (ACVI) is one of the most abundantly expressed beta adrenergic receptor (betaAR)-coupled cyclases responsible for cyclic AMP (cAMP) production within the mammalian myocardium. We investigated the role of ACVI in the regulation of cardiomyocyte contractility and whether it is functionally coupled with beta(1) adrenergic receptor (beta(1)AR). 2. Recombinant adenoviruses were generated for ACVI and for antisense to ACVI (AS). Adult rat ventricular myocytes were transfected with ACVI virus, AS or both (SAS). Adenovirus for green fluorescent protein (GFP) served as control. Myocyte contraction amplitudes (% shortening) and relaxation times (R50) were analysed. ACVI function was determined using cAMP assays. 3. ACVI-transfected cells demonstrated a strong 139 kDa ACVI protein band compared to controls. ACVI myocytes had higher steady-state intracellular cAMP levels than GFP myocytes when unstimulated (GFP vs ACVI=6.60+/-0.98 vs 14.2+/-2.1 fmol cAMP/viable cell, n=4, P<0.05) and in the presence of 1 microm isoprenaline or 10 microm forskolin. 4. ACVI myocytes had increased basal contraction (% shortening: GFP vs ACVI: 1.90+/-1.36 vs 3.91+/-2.29, P<0.0001) and decreased basal R50 (GFP vs ACVI: 62.6+/-24.2 ms (n=50) vs 45.0+/-17.2 ms (n=248), P<0.0001). ACVI myocyte responses were increased for forskolin (E(max): GFP=6.70+/-1.59 (n=6); ACVI=9.06+/-0.69 (n=14), P<0.01) but not isoprenaline. 5. ACVI myocyte responses were increased (E(max): GFP vs ACVI=3.16+/-0.77 vs 5.10+/-0.60, P<0.0001) to xamoterol (a partial beta(1)AR-selective agonist) under beta(2)AR blockade (+50 nm ICI 118, 551). AS decreased both control and ACVI-stimulated xamoterol responses (E(max): AS=2.59+/-1.42, SAS=1.38+/-0.5). ACVI response was not mimicked by IBMX. Conversely, response through beta(2) adrenergic receptor (beta(2)AR) was decreased in ACVI myocytes. 6. In conclusion, ACVI overexpression constitutively increases myocyte contraction amplitudes by raising cAMP levels. Native ACVI did not contribute to basal cAMP production or contraction amplitude and only to a minor extent to the forskolin response. beta(1)AR but not beta(2)AR coupling was dependent on ACVI.


Assuntos
Adenilil Ciclases/biossíntese , Regulação Enzimológica da Expressão Gênica/fisiologia , Miócitos Cardíacos/enzimologia , Receptores Adrenérgicos beta 1/metabolismo , Receptores Adrenérgicos beta 2/metabolismo , Agonistas de Receptores Adrenérgicos beta 1 , Agonistas de Receptores Adrenérgicos beta 2 , Animais , Linhagem Celular , Células Cultivadas , Relação Dose-Resposta a Droga , Regulação Enzimológica da Expressão Gênica/efeitos dos fármacos , Ventrículos do Coração/efeitos dos fármacos , Ventrículos do Coração/enzimologia , Humanos , Isoproterenol/farmacologia , Masculino , Miócitos Cardíacos/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley
11.
J Biotechnol ; 113(1-3): 55-68, 2004 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-15380647

RESUMO

A type I PKS gene probe obtained from RAPB of the rapamycin producer Streptomyces hygroscopicus, strongly hybridised to 92 out of 1120 cosmids from a genomic library of the elaiophylin-producing strain Streptomyces sp. DSM4137. Partial cosmid sequencing suggested the presence of 10 separate sequences encoding type I PKS genes. One entire DNA sequence was obtained and found exactly to match the gene organisation expected for the biosynthesis of the unusual macrodiolide polyketide elaiophylin. The putative elaiophylin gene cluster contains five large open-reading frames encoding typical modular polyketide synthases, which together catalyse the synthesis of the octaketide monomer of elaiophylin. Other genes were identified that would be required for provision of the ethylmalonate extender unit, for the synthesis and attachment of 2-deoxy-L-fucose and in regulation, or in export of the product. Immediately adjacent to the putative elaiophylin biosynthetic gene cluster is a 30-kbp region containing the gene for adenosylcobalamin-dependent methylmalonyl CoA mutase and also genes involved in the biosynthesis of the cobalamin cofactor. Analysis of the latter gene set confirms the view that cbiD of the anaerobic pathway and cobF in the aerobic pathway catalyse the same methylation of precorrin-5. The proximity of these genes to the putative elaiophylin gene cluster can best be rationalised if in this organism succinyl-CoA is a significant source of the methylmalonate units for complex polyketide biosynthesis.


Assuntos
Cobamidas/biossíntese , Macrolídeos/metabolismo , Metilmalonil-CoA Mutase/genética , Streptomyces/genética , Streptomyces/metabolismo , Carboidratos/biossíntese , Clonagem Molecular , Genes Bacterianos/genética , Genoma Bacteriano , Macrolídeos/química , Metilmalonil-CoA Mutase/metabolismo , Fases de Leitura Aberta
12.
Chem Biol ; 11(1): 107-19, 2004 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15113000

RESUMO

The gene cluster encoding biosynthesis of the clinically important glycopeptide antibiotic teicoplanin has been cloned from Actinoplanes teichomyceticus. Forty-nine putative open reading frames (ORFs) were identified within an 89 kbp genetic locus and assigned roles in teicoplanin biosynthesis, export, resistance, and regulation. Two ORFs, designated orfs 1 and 10*, showed significant homology to known glycosyltransferases. When heterologously expressed in Escherichia coli, these glycosyltransferases were shown to catalyze the transfer of UDP-(N-acetyl)-glucosamine onto, respectively, 3-chloro-beta-hydroxytyrosine-6 (3-Cl-6betaHty) and 4-hydroxyphenylglycine-4 (4Hpg) of the teicoplanin heptapeptide aglycone. The product of another ORF, orf11*, was demonstrated in vitro to transfer n-acetyl-, n-butyryl-, and n-octanoyl-groups from acyl-CoA donors either to a free UDP-aminosugar or to an aminosugar moiety in the teicoplanin pseudoaglycone, thus identifying Orf11* as the key acyltransferase in teicoplanin maturation. These findings should accelerate the combinatorial engineering of new and improved glycopeptide drugs.


Assuntos
Actinomycetales/genética , Aciltransferases/genética , Antibacterianos/biossíntese , Genes Bacterianos , Glicosiltransferases/genética , Teicoplanina/biossíntese , Actinomycetales/enzimologia , Actinomycetales/metabolismo , Aciltransferases/isolamento & purificação , Aciltransferases/metabolismo , Antibacterianos/química , Clonagem Molecular , Ciclização , Resistência a Medicamentos/genética , Glicosiltransferases/isolamento & purificação , Glicosiltransferases/metabolismo , Halogênios/metabolismo , Humanos , Masculino , Dados de Sequência Molecular , Estrutura Molecular , Família Multigênica/genética , Análise de Sequência de DNA , Teicoplanina/química
13.
Proc Natl Acad Sci U S A ; 101(5): 1345-9, 2004 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-14736915

RESUMO

Mycobacterium ulcerans (MU), an emerging human pathogen harbored by aquatic insects, is the causative agent of Buruli ulcer, a devastating skin disease rife throughout Central and West Africa. Mycolactone, an unusual macrolide with cytotoxic and immunosuppressive properties, is responsible for the massive s.c. tissue destruction seen in Buruli ulcer. Here, we show that MU contains a 174-kb plasmid, pMUM001, bearing a cluster of genes encoding giant polyketide synthases (PKSs), and polyketide-modifying enzymes, and demonstrate that these are necessary and sufficient for mycolactone synthesis. This is a previously uncharacterized example of plasmid-mediated virulence in a Mycobacterium, and the emergence of MU as a pathogen most likely reflects the acquisition of pMUM001 by horizontal transfer. The 12-membered core of mycolactone is produced by two giant, modular PKSs, MLSA1 (1.8 MDa) and MLSA2 (0.26 MDa), whereas its side chain is synthesized by MLSB (1.2 MDa), a third modular PKS highly related to MLSA1. There is an extreme level of sequence identity within the different domains of the MLS cluster (>97% amino acid identity), so much so that the 16 ketosynthase domains seem functionally identical. This is a finding of significant consequence for our understanding of polyketide biochemistry. Such detailed knowledge of mycolactone will further the investigation of its mode of action and the development of urgently needed therapeutic strategies to combat Buruli ulcer.


Assuntos
Toxinas Bacterianas/genética , Lactonas/metabolismo , Complexos Multienzimáticos/genética , Mycobacterium ulcerans/genética , Mycobacterium ulcerans/patogenicidade , Plasmídeos , Sequência de Bases , Elementos de DNA Transponíveis , Macrolídeos , Dados de Sequência Molecular , Família Multigênica , Mutagênese Insercional
14.
J Hypertens ; 20(4): 771-7, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11910315

RESUMO

OBJECTIVE: Hypertension guidelines recommend initial treatment with a beta-blocker or diuretic and adding the other drug where blood pressure is not controlled. We hypothesized that systematic rotation through the major classes of antihypertensive drugs would demonstrate substantial differences in the pattern of an individual patient's response, and suggest a more rational approach to choosing best treatment. DESIGN: Thirty-four young hypertensives (age 28-55, median 47) rotated in a double-blind, Latin-square, crossover fashion through 6 weeks of treatment each with amlodipine, doxazosin, lisinopril, bisoprolol, bendrofluazide and placebo. Blood pressure was measured at each visit. 'Best' drug, defined by efficacy and tolerability, was repeated at the end. RESULTS: Rotation doubled the number of patients reaching target blood pressure (systolic < 140 mmHg) on one drug (P = 0.03). All five drugs were represented among the 'best' drugs. In six patients, the blood pressure on 'best' drug was at least 10 mmHg lower than on any other. Response to the 'best' drug was highly correlated (r = 0.79) with its previous administration. By contrast, there were only weak correlations between responses to pairs of drugs, except for angiotensin-converting enzyme (ACE) inhibitor (A) with beta-blocker (B), and calcium blocker (C) with diuretic (D) - each r = 0.71, P < 0.005). In these young patients, the majority of patients (23/34) responded best to a drug suppressing the renin system (A and B). CONCLUSIONS: Patients vary reproducibly in their response to initial treatment, and switching among drugs can increase the efficacy of monotherapy. The results support an AB/CD scheme for choosing therapy, in which the first drug is taken from one of these pairs, and uncontrolled patients switch to one of the other pair.


Assuntos
Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/classificação , Hipertensão/tratamento farmacológico , Antagonistas Adrenérgicos alfa/administração & dosagem , Antagonistas Adrenérgicos beta/administração & dosagem , Adulto , Anlodipino/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Bendroflumetiazida/administração & dosagem , Bisoprolol/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Bloqueadores dos Canais de Cálcio/administração & dosagem , Estudos Cross-Over , Diuréticos , Método Duplo-Cego , Doxazossina/administração & dosagem , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipertensão/fisiopatologia , Lisinopril/administração & dosagem , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Sistema Renina-Angiotensina/efeitos dos fármacos , Inibidores de Simportadores de Cloreto de Sódio/administração & dosagem
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