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2.
Neurology ; 96(1): e67-e80, 2021 01 05.
Artículo en Inglés | MEDLINE | ID: mdl-33154085

RESUMEN

OBJECTIVE: To assess whether angiotensin II-stimulating antihypertensives (thiazides, dihydropyridine calcium channel blockers, and angiotensin I receptor blockers) convey a lower risk of incident dementia compared to angiotensin II-inhibiting antihypertensives (angiotensin-converting enzyme inhibitors, ß-blockers, and nondihydropyridine calcium channel blockers), in accordance with the "angiotensin hypothesis." METHODS: We performed Cox regression analyses of incident dementia (or mortality as competing risk) during 6-8 years of follow-up in a population sample of 1,909 community-dwelling individuals (54% women) without dementia, aged 70-78 (mean 74.5 ± 2.5) years. RESULTS: After a median of 6.7 years of follow-up, dementia status was available for 1,870 (98%) and mortality for 1,904 (>99%) participants. Dementia incidence was 5.6% (27/480) in angiotensin II-stimulating, 8.2% (59/721) in angiotensin II-inhibiting, and 6.9% (46/669) in both antihypertensive type users. Adjusted for dementia risk factors including blood pressure and medical history, angiotensin II-stimulating antihypertensive users had a 45% lower incident dementia rate (hazard ratio [HR], 0.55; 95% CI, 0.34-0.89) without excess mortality (HR, 0.86; 95% CI, 0.64-1.16), and individuals using both types had a nonsignificant 20% lower dementia rate (HR, 0.80; 95% CI,0.53-1.20) without excess mortality (HR, 0.97; 95% CI, 0.76-1.24), compared to angiotensin II-inhibiting antihypertensive users. Results were consistent for subgroups based on diabetes and stroke history, but may be specific for individuals without a history of cardiovascular disease. CONCLUSIONS: Users of angiotensin II-stimulating antihypertensives had lower dementia rates compared to angiotensin II-inhibiting antihypertensive users, supporting the angiotensin hypothesis. Confounding by indication must be examined further, although subanalyses suggest this did not influence results. If replicated, dementia prevention could become a compelling indication for older individuals receiving antihypertensive treatment.


Asunto(s)
Angiotensina II/efectos de los fármacos , Antihipertensivos/uso terapéutico , Demencia/epidemiología , Anciano , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Incidencia , Masculino , Inhibidores de los Simportadores del Cloruro de Sodio/uso terapéutico
3.
J Hypertens ; 39(1): 190-195, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33273364

RESUMEN

BACKGROUND: The Covid-19 pandemic caused a shutdown of healthcare systems in many countries. We explored the impact on hypertension care in the Excellence Center (EC) network of the European Society of Hypertension. METHODS: We conducted a 17-question electronic survey among ECs. RESULTS: Overall, 52 ECs from 20 European and three non-European countries participated, providing hypertension service for a median of 1500 hypertensive patients per center per year. Eighty-five percent of the ECs reported a shutdown lasting for 9 weeks (range 0-16). The number of patients treated per week decreased by 90%: from a median of 50 (range 10-400) before the pandemic to a median of 5.0 (range 0-150) during the pandemic (P < 0.0001). 60% of patients (range 0-100%) declared limited access to medical consultations. The majority of ECs (57%) could not provide 24-h ambulatory BP monitoring, whereas a median of 63% (range 0-100%) of the patients were regularly performing home BP monitoring. In the majority (75%) of the ECs, hypertension service returned to normal after the first wave of the pandemic. In 66% of the ECs, the physicians received many questions regarding the use of renin-angiotensin system (RAS) blockers. Stopping RAS-blocker therapy (in a few patients) either by patients or physicians was reported in 27 and 36.5% of the ECs. CONCLUSION: Patient care in hypertension ECs was compromised during the Covid-19-related shutdown. These data highlight the necessity to develop new strategies for hypertension care including virtual clinics to maintain services during challenging times.


Asunto(s)
/epidemiología , Instituciones de Salud , Accesibilidad a los Servicios de Salud , Hipertensión/tratamiento farmacológico , Pandemias , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial , Prestación de Atención de Salud , Europa (Continente)/epidemiología , Humanos , Sistema Renina-Angiotensina , Encuestas y Cuestionarios
4.
PLoS One ; 15(12): e0244708, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33378401

RESUMEN

BACKGROUND: Retrospective studies on the use of Renin-Angiotensin-Aldosterone System blockade in patients with Coronavirus Disease 2019 (COVID-19) have been informative but conflicting, and prospective studies are required to demonstrate the safety, tolerability, and outcomes of initiating these agents in hospitalized patients with COVID-19 and hypertension. METHODS AND FINDINGS: This is a single center feasibility study encompassing two cohorts: (1) prospective cohort (April 21, 2020 to May 29, 2020) and (2) retrospective cohort (March 7, 2020 to April 1, 2020) of hospitalized patients with real-time polymerase chain reaction (PCR) positive SARS-CoV-2 by nasopharyngeal swab. Key inclusion criteria include BP > 130/80 and a requirement of supplemental oxygen with FiO2 of 25% or higher to maintain SpO2 > 92%. Key exclusion criteria included hyperkalemia and acute kidney injury (AKI) at the time of enrollment. Prospective cohort consisted of de novo initiation of losartan and continuation for a minimum of 7 days and assessed for adverse events (AKI, hyperkalemia, transaminitis, hypotension) and clinical outcomes (change in SpO2/FiO2 and inflammatory markers, need for ICU admission and mechanical ventilation). Retrospective cohort consisted of continuation of losartan (prior-to-hospitalization) and assessment of similar outcomes. In the prospective cohort, a total of 250 hospitalized patients were screened and inclusion/exclusion criteria were met in 16/250 patients and in the retrospective cohort, a total of 317 hospitalized patients were screened and inclusion/exclusion criteria were met in 14/317 patients. Most common adverse event was hypotension, leading to discontinuation in 3/16 (19%) and 2/14 (14%) patients in the prospective and retrospective cohort. No patients developed AKI in the prospective cohort as compared to 1/14 (7%) patients in the retrospective cohort, requiring discontinuation of losartan. Hyperkalemia occurred in 1/16 (6%) and 0/14 patients in the prospective and retrospective cohorts, respectively. In the prospective cohort, 3/16 (19%) and 2/16 (13%) patients required ICU admission and mechanical ventilation. In comparison, 3/14 (21%) required ICU admission and mechanical ventilation in the retrospective cohort. A majority of patients in both cohorts (14/16 (88%) and 13/14 (93%) patients from the prospective and retrospective cohort) were discharged alive from the hospital. A total of 9/16 (prospective) and 5/14 (retrospective) patients completed a minimum 7 days of losartan. In these 9 patients in the prospective cohort, a significant improvement in SpO2/FiO2 ratio was observed from day 1 to 7. No significant changes in inflammatory markers (initiation, peak, and day 7) were observed in either cohort. CONCLUSION: In this pilot study we demonstrate that losartan was well-tolerated among hospitalized patients with COVID-19 and hypertension. We also demonstrate the feasibility of patient recruitment and the appropriate parameters to assess the outcomes and safety of losartan initiation or continuation, which provides a framework for future randomized clinical trials.


Asunto(s)
Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Hipertensión/tratamiento farmacológico , Losartán/uso terapéutico , Anciano , Bloqueadores del Receptor Tipo 1 de Angiotensina II/efectos adversos , Presión Sanguínea/efectos de los fármacos , Femenino , Humanos , Losartán/efectos adversos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Estudios Retrospectivos
5.
Cochrane Database Syst Rev ; 12: CD004349, 2020 12 17.
Artículo en Inglés | MEDLINE | ID: mdl-33332584

RESUMEN

BACKGROUND: This is the first update of this review first published in 2009. When treating elevated blood pressure, doctors usually try to achieve a blood pressure target. That target is the blood pressure value below which the optimal clinical benefit is supposedly obtained. "The lower the better" approach that guided the treatment of elevated blood pressure for many years was challenged during the last decade due to lack of evidence from randomised trials supporting that strategy. For that reason, the standard blood pressure target in clinical practice during the last years has been less than 140/90 mm Hg for the general population of patients with elevated blood pressure. However, new trials published in recent years have reintroduced the idea of trying to achieve lower blood pressure targets. Therefore, it is important to know whether the benefits outweigh harms when attempting to achieve targets lower than the standard target. OBJECTIVES: The primary objective was to determine if lower blood pressure targets (any target less than or equal to 135/85 mm Hg) are associated with reduction in mortality and morbidity as compared with standard blood pressure targets (less than or equal to 140/ 90 mm Hg) for the treatment of patients with chronic arterial hypertension. The secondary objectives were: to determine if there is a change in mean achieved systolic blood pressure (SBP) and diastolic blood pressure (DBP associated with "lower targets" as compared with "standard targets" in patients with chronic arterial hypertension; and to determine if there is a change in withdrawals due to adverse events with "lower targets" as compared with "standard targets", in patients with elevated blood pressure. SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to May 2019: the Cochrane Hypertension Specialised Register, CENTRAL (2019, Issue 4), Ovid MEDLINE, Ovid Embase, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing patients allocated to lower or to standard blood pressure targets (see above). DATA COLLECTION AND ANALYSIS: Two review authors (JAA, VL) independently assessed the included trials and extracted data. Primary outcomes were total mortality; total serious adverse events; myocardial infarction, stroke, congestive heart failure, end stage renal disease, and other serious adverse events. Secondary outcomes were achieved mean SBP and DBP, withdrawals due to adverse effects, and mean number of antihypertensive drugs used. We assessed the risk of bias of each trial using the Cochrane risk of bias tool and the certainty of the evidence using the GRADE approach.  MAIN RESULTS: This update includes 11 RCTs involving 38,688 participants with a mean follow-up of 3.7 years. This represents 7 new RCTs compared with the original version. At baseline the mean weighted age was 63.1 years and the mean weighted blood pressure was 155/91 mm Hg. Lower targets do not reduce total mortality (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.86 to 1.05; 11 trials, 38,688 participants; high-certainty evidence) and do not reduce total serious adverse events (RR 1.04, 95% CI 0.99 to 1.08; 6 trials, 18,165 participants; moderate-certainty evidence). This means that the benefits of lower targets do not outweigh the harms as compared to standard blood pressure targets. Lower targets may reduce myocardial infarction (RR 0.84, 95% CI 0.73 to 0.96; 6 trials, 18,938 participants, absolute risk reduction (ARR) 0.4%, number needed to treat to benefit (NNTB) 250 over 3.7 years) and congestive heart failure (RR 0.75, 95% CI 0.60 to 0.92; 5 trials, 15,859 participants, ARR 0.6%, NNTB  167 over 3.7 years) (low-certainty for both outcomes). Reduction in myocardial infarction and congestive heart failure was not reflected in total serious adverse events. This may be due to an increase in other serious adverse events (RR 1.44, 95% CI 1.32 to 1.59; 6 trials. 18,938 participants, absolute risk increase (ARI) 3%,  number needed to treat to harm (NNTH) 33 over four years) (low-certainty evidence). Participants assigned to a "lower" target received one additional antihypertensive medication and achieved a significantly lower mean SBP (122.8 mm Hg versus 135.0 mm Hg, and a lower mean DBP (82.0 mm Hg versus 85.2 mm Hg, than those assigned to "standard target". AUTHORS' CONCLUSIONS: For the general population of persons with elevated blood pressure, the benefits of trying to achieve a lower blood pressure target rather than a standard target (≤ 140/90 mm Hg) do not outweigh the harms associated with that intervention. Further research is needed to see if some groups of patients would benefit or be harmed by lower targets. The results of this review are primarily applicable to older people with moderate to high cardiovascular risk. They may not be applicable to other populations.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/fisiología , Hipertensión/tratamiento farmacológico , Sesgo , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Intervalos de Confianza , Diástole/fisiología , Guías como Asunto , Insuficiencia Cardíaca/prevención & control , Humanos , Hipertensión/mortalidad , Fallo Renal Crónico/mortalidad , Persona de Mediana Edad , Infarto del Miocardio/prevención & control , Números Necesarios a Tratar , Ensayos Clínicos Controlados Aleatorios como Asunto , Valores de Referencia , Accidente Cerebrovascular/epidemiología
6.
PLoS One ; 15(12): e0244349, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33347477

RESUMEN

BACKGROUND: Angiotensin-converting enzyme 2 is the receptor that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses for entry into lung cells. Because ACE-2 may be modulated by angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), there is concern that patients treated with ACEIs and ARBs are at higher risk of coronavirus disease 2019 (COVID-19) pneumonia. AIM: This study sought to analyze the association of COVID-19 pneumonia with previous treatment with ACEIs and ARBs. MATERIALS AND METHODS: We retrospectively reviewed 684 consecutive patients hospitalized for suspected COVID-19 pneumonia and tested by polymerase chain reaction assay. Patients were split into two groups, according to whether (group 1, n = 484) or not (group 2, n = 250) COVID-19 was confirmed. Multivariable adjusted comparisons included a propensity score analysis. RESULTS: The mean age was 63.6 ± 18.7 years, and 302 patients (44%) were female. Hypertension was present in 42.6% and 38.4% of patients in groups 1 and 2, respectively (P = 0.28). Treatment with ARBs was more frequent in group 1 than group 2 (20.7% vs. 12.0%, respectively; odds ratio [OR] 1.92, 95% confidence interval [CI] 1.23-2.98; P = 0.004). No difference was found for treatment with ACEIs (12.7% vs. 15.7%, respectively; OR 0.81, 95% CI 0.52-1.26; P = 0.35). Propensity score-matched multivariable logistic regression confirmed a significant association between COVID-19 and previous treatment with ARBs (adjusted OR 2.36, 95% CI 1.38-4.04; P = 0.002). Significant interaction between ARBs and ACEIs for the risk of COVID-19 was observed in patients aged > 60 years, women, and hypertensive patients. CONCLUSIONS: This study suggests that ACEIs and ARBs are not similarly associated with COVID-19. In this retrospective series, patients with COVID-19 pneumonia more frequently had previous treatment with ARBs compared with patients without COVID-19.


Asunto(s)
Bloqueadores del Receptor Tipo 2 de Angiotensina II/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Neumonía/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Bloqueadores del Receptor Tipo 2 de Angiotensina II/uso terapéutico , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Neumonía/diagnóstico , Estudios Retrospectivos , Factores de Riesgo
7.
Iran J Kidney Dis ; 14(6): 482-487, 2020 12 05.
Artículo en Inglés | MEDLINE | ID: mdl-33277453

RESUMEN

INTRODUCTION: Diabetes mellitus and hypertension are described as the most common comorbidities among COVID-19 patients. We investigated the adverse effect of ACEIs in diabetic and nondiabetic patients with COVID-19. METHODS: This prospective study consisted of 617 RT-PCR-confirmed COVID-19 inpatients. Demographic and baseline characteristics, underlying comorbid diseases, and antihypertensive drugs were evaluated. Study outcome (in-hospital death) was evaluated with the Kaplan-Meyer method and Cox regression model. Statistical analyses were performed with SPSS software for Windows. P values < .05 were considered significant. RESULTS: Mean ± SD age was 58.49 ± 15.80 (range: 18 to 94) years old. Cox regression analysis revealed that age (adjusted hazard ratio [HR] = 1.04, 95% CI: 1.03 to 1.06), diabetes mellitus (adjusted HR = 2.07, 95% CI: 1.32 to 3.26), immunocompromised patients (adjusted HR = 2.33, 95% CI: 1.29 to 4.21), acute kidney injury (AKI) (adjusted HR = 3.23, 95% CI: 2.01 to 5.19), ICU admission (adjusted HR = 2.48, 95% CI: 1.46 to 4.21), Asthma and COPD (adjusted HR = 2.13, CI:1.6 to 4.28) and ACEI (adjusted HR = 3.08, 95% CI: 1.56 to 6.06), respectively were associated with in-hospital death. Among diabetic patients, ACEI (adjusted HR = 3.51, 95% CI: 1.59 to 7.75), AKI (adjusted HR = 3.32, 95% CI: 1.76 to 6.45) and ICU admission (adjusted HR = 3.64, 95% CI: 1.530 to 8.65) were associated with increased mortality. The Kaplan-Meier survival curve showed a lower survival rate in diabetic patients with ACE inhibitor (adjusted HR = 3.36, 95% CI: 2.25 to 7.71). CONCLUSION: ACEIs may harm the diabetic patient's outcome with COVID-19. Further studies can confirm if ACE inhibitors have an adverse effect on COVID-19 diabetic patient's mortality.


Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antihipertensivos/efectos adversos , Diabetes Mellitus/epidemiología , Mortalidad Hospitalaria , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Comorbilidad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Irán/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Análisis de Supervivencia , Adulto Joven
8.
Adv Chronic Kidney Dis ; 27(5): 404-411, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-33308506

RESUMEN

Hypertension emerged from early reports as a potential risk factor for worse outcomes for persons with coronavirus disease 2019 (COVID-19). Among the putative links between hypertension and COVID-19 is a key counter-regulatory component of the renin-angiotensin system (RAS): angiotensin-converting enzyme 2 (ACE2). ACE2 facilitates entry of severe acute respiratory syndrome coronavirus 2, the virus responsible for COVID-19, into host cells. Because RAS inhibitors have been suggested to increase ACE2 expression, health-care providers and patients have grappled with the decision of whether to discontinue these medications during the COVID-19 pandemic. However, experimental models of analogous viral pneumonias suggest RAS inhibitors may exert protective effects against acute lung injury. We review how RAS and ACE2 biology may affect outcomes in COVID-19 through pulmonary and other systemic effects. In addition, we briefly detail the data for and against continuation of RAS inhibitors in persons with COVID-19 and summarize the current consensus recommendations from select specialty organizations.


Asunto(s)
Lesión Pulmonar Aguda/metabolismo , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Hipertensión/tratamiento farmacológico , Lesión Pulmonar Aguda/epidemiología , Lesión Pulmonar Aguda/inmunología , Angiotensina I/inmunología , Angiotensina I/metabolismo , Angiotensina II/inmunología , Angiotensina II/metabolismo , /epidemiología , Comorbilidad , Humanos , Hipertensión/epidemiología , Hipertensión/metabolismo , Proteínas Quinasas JNK Activadas por Mitógenos/inmunología , Proteínas Quinasas JNK Activadas por Mitógenos/metabolismo , Pulmón/inmunología , Pulmón/metabolismo , Sistema de Señalización de MAP Quinasas , Fragmentos de Péptidos/inmunología , Fragmentos de Péptidos/metabolismo , Factores Protectores , /metabolismo , Sistema Renina-Angiotensina , Factores de Riesgo , Regulación hacia Arriba
9.
J Int Med Res ; 48(12): 300060520979151, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33322988

RESUMEN

OBJECTIVE: Association of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) use with coronavirus disease 2019 (COVID-19) remains controversial. We aimed to investigate the impact of ACEI/ARB use on all-cause mortality in severe COVID-19 patients with hypertension. METHODS: We enrolled 650 COVID-19 patients from Changsha and Wuhan city between 17 January 2020 and 8 March 2020. Demographic, clinical characteristics, and outcomes were collected. Multivariable analysis and propensity-score matching were performed to assess the impact of ACEI/ARB therapy on mortality. RESULTS: Among the 650 patients, 126 who had severe COVID-19 concomitant with hypertension were analyzed. The average age was 66 years and 56 (44.4%) were men. There were 37 ACEI/ARB users and 21 in-hospital deaths (mortality rate, 16.7%). Male sex (odds ratio [OR], 5.13; 95% confidence interval [CI], 1.75 to 17.8), but not ACEI/ARB use (OR, 1.09; 95%CI, 0.31 to 3.43), was an independent risk factor for mortality in severe COVID-19 patients with hypertension. After propensity-score matching, 60 severe COVID-19 patients were included and no significant correlation between use of ACEI/ARB and mortality was observed. CONCLUSIONS: There was no significant association of ACEI/ARB use with mortality in severe COVID-19 patients with hypertension. These findings support the continuation of ACEI/ARB therapy for such patients.


Asunto(s)
Antagonistas de Receptores de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Hipertensión/tratamiento farmacológico , Anciano , /complicaciones , /virología , Femenino , Regulación de la Expresión Génica/efectos de los fármacos , Mortalidad Hospitalaria , Humanos , Hipertensión/complicaciones , Masculino , Pandemias , Sistema Renina-Angiotensina/efectos de los fármacos , Estudios Retrospectivos , Factores de Riesgo , /patogenicidad , Índice de Severidad de la Enfermedad , Glicoproteína de la Espiga del Coronavirus/metabolismo , Internalización del Virus/efectos de los fármacos
10.
Probl Endokrinol (Mosk) ; 66(1): 35-46, 2020 08 04.
Artículo en Ruso | MEDLINE | ID: mdl-33351311

RESUMEN

BACKGROUND: Data on the national level and worldwide show a higher rate of mortality in patients with diabetes mellitus (DM) due to COVID-19, which determines the high relevance of risk factor analysis for outcomes in DM patients to substantiate the strategy for this category of patients. AIM: To assess the effect of clinical and demographic parameters (age, gender, body mass index (BMI), glycemic control (HbA1c), and antidiabetic and antihypertensive drugs, including ACE inhibitors and ARBs) on clinical outcomes (recovery or death) in patients with type 2 DM. MATERIALS AND METHODS: A retrospective analysis of the Russian Register of Diabetes database was performed, including patients with type 2 DM (n=309) who suffered pneumonia/COVID-19 in the period from 01.02.2020 to 27.04.2020 and the indicated outcome of the disease (recovery or death) RESULTS: The percentage of lethality was determined to be 15.2% (47 of 309 people). The degree of lethality was found to be significantly higher in males (OR=2.08; 95% CI 1.1–3.9; p=0.022) and in patients on insulin therapy (OR=2.67; 95% CI; 1.42–5.02; p=0.002), while it was significantly lower in patients with an age <65 years (OR=0.34; 95% CI 0.18–0.67; p=0.001) and in patients receiving metformin (OR=0.26; 95% CI 0.14–0,5; p<0.0001), antihypertensive therapy (OR=0.43; 95% CI 0.22–0.82; p=0.009), β-blockers (OR=0.26; 95% CI 0.08–0.86; p=0.018), diuretics (OR=0.4; 95% CI 0.17–0.93; p=0.028) and renin-angiotensin system blockers (ACE inhibitors or ARBs) (OR=0.36; 95% CI 0.18–0.74; p=0.004). A tendency to an increase in lethality at higher rates of HbA1c and BMI was present, but it did not reach a statistical significance. Differences between patients receiving insulin therapy and those who were not receiving the insulin therapy were observed as follows: a significantly longer duration of type 2 DM (13.4 vs. 6.8 years, respectively; p<0.0001), worse overall glyacemic control (HbA1c: 8.1% vs. 7.0%, resp.; p<0.0001), and three times more frequent failure to achieve the HbA1c goal by more than 2.5% (14.7% vs. 5.9%, resp.; p=0.04). CONCLUSION: The identified risk factors for lethality in patients with type 2 DM indicate that good glycemic control and previous treatment with metformin and antihypertensive drugs (including RAS blockers) could reduce the frequency of deaths. In patients on insulin therapy, a higher lethality degree was associated with worse glycemic control.


Asunto(s)
/mortalidad , Complicaciones de la Diabetes/mortalidad , Diabetes Mellitus/mortalidad , Hipertensión/mortalidad , Anciano , Anciano de 80 o más Años , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/efectos adversos , Antihipertensivos/uso terapéutico , /tratamiento farmacológico , Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/virología , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/virología , Diuréticos/efectos adversos , Diuréticos/uso terapéutico , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Hipertensión/virología , Insulina/metabolismo , Masculino , Metformina/efectos adversos , Metformina/uso terapéutico , Federación de Rusia/epidemiología , /patogenicidad
11.
Med. clín (Ed. impr.) ; 155(11): 473-481, dic. 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-192583

RESUMEN

INTRODUCCIÓN: La presencia de hipertensión arterial se asocia con peor pronóstico en pacientes con COVID-19, y se ha sugerido que el uso de inhibidores del eje renina-angiotensina puede influir en el pronóstico de los pacientes. MÉTODOS: Registro observacional de 921 pacientes consecutivos ingresados por infección respiratoria COVID-19 entre el 1 de marzo y el 30 abril de 2020 en el Hospital General Universitario de Ciudad Real. Se registraron datos clínicos y analíticos, intervenciones terapéuticas y desarrollo de eventos durante el ingreso hospitalario. RESULTADOS: La mediana de edad fue de 78 años y el 59,2% tenían hipertensión arterial. Aunque el perfil clínico fue más desfavorable en el grupo de pacientes con prescripción previa de IECA o ARA2 respecto al resto, los primeros presentaron menor riesgo de desarrollo del evento primario combinado (mortalidad total o necesidad de soporte ventilatorio invasivo). Asimismo, el empleo previo al ingreso o durante el mismo de estos fármacos mostró un efecto neutro sobre la mortalidad total y sobre la necesidad de ventilación mecánica invasiva. En el análisis de supervivencia no se observó mayor riesgo de presentar más precozmente ninguno de los eventos registrados. CONCLUSIONES: La prescripción previa al ingreso por infección respiratoria COVID-19 de inhibidores del eje renina-angiotensina se asoció a un menor riesgo de desarrollo del evento primario combinado y a un efecto neutro sobre la mortalidad total y sobre la necesidad de ventilación mecánica invasiva


INTRODUCTION: Hypertension has been associated with worse outcomes in patients with COVID-19 infection, so concerns have been raised about the possibility that inhibitors of the renin-angiotensin system (RAS) could influence the prognosis of these patients. METHODS: This is an observational study of 921 consecutive patients admitted with COVID-19 respiratory infection to Hospital General Universitario Ciudad Real from March 1 to April 30, 2020. Following data were collected including patient demographic information, medical history, clinical characteristics, laboratory data, therapeutic interventions during the hospitalization and clinical outcomes. RESULTS: The mean age was 78 years, and 59.2% of patients had a history of hypertension. Patients with previous treatment with RAS inhibitor (42.4%) showed lower risk of the primary composite endpoint (mortality or need for invasive mechanical ventilation). Treatment with RAS inhibitor (both outpatient treatment and during hospitalization) had neither effect on mortality nor need for invasive ventilation. There were no differences in time-to-event analysis between groups. CONCLUSIONS: RAS inhibitor treatment prior to admission in patients with COVID-19 respiratory infection was associated with lower risk of the primary composite endpoint and did not show neither impact on mortality nor need for invasive mechanical ventilation, even if these drugs were prescribed during hospitalization


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Hipertensión/complicaciones , Pronóstico , Estudios de Cohortes , Pandemias , Betacoronavirus , Hospitalización , Sistema Renina-Angiotensina , Servicios de Atención de Salud a Domicilio , Hipertensión/tratamiento farmacológico , Modelos Logísticos , Análisis de Supervivencia
13.
Med Hypotheses ; 144: 110186, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33254506

RESUMEN

COVID-19, caused by the novel coronavirus SARS-CoV-2, is an abbreviated name for coronavirus disease 2019. COVID-19 became a global pandemic in early 2020. It predominantly affects not only the upper and lower respiratory tract, but also multiple organs, including the kidney, heart, and brain. The mortality of COVID-19 patients is high in men and in elderly patients with age-related diseases such as hypertension and diabetes. The angiotensin converting enzyme-2 (ACE-2), a component in the renin-angiotensin-aldosterone system (RAAS), plays as cell surface receptors for SARS-CoV-2. A recent study proved that coronavirus SARS-CoV-2 also uses dipeptidyl peptidase-4 (DPP4, also known as adenosine deaminase complexing protein 2, CD26) as a co-receptor when entering cells. In addition, DPP4 is also implicated in the regulation of the immune response. Thus, the combination of DPP4 inhibition and suppression of ACE-2/RAAS may be a novel therapeutic strategy for combating this pandemic.


Asunto(s)
/tratamiento farmacológico , Dipeptidil Peptidasa 4/metabolismo , Sistema Renina-Angiotensina/efectos de los fármacos , Anciano , /complicaciones , Citocinas/metabolismo , Complicaciones de la Diabetes/tratamiento farmacológico , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Sistema Inmunológico , Inflamación , Masculino , Internalización del Virus , Replicación Viral
14.
Zhongguo Zhong Yao Za Zhi ; 45(22): 5383-5392, 2020 Nov.
Artículo en Chino | MEDLINE | ID: mdl-33350197

RESUMEN

Hypertension is a kind of chronic cardiovascular system disease caused by a series of factors and carriers dysfunction, which belongs to the category of Tibetan medicine "Chalong disease", and has a high rate of disability and mortality. Zuomua Decoction is a classical Tibetan medicine for Chalong disease, but its mechanism is not clear. Therefore, in this paper we explored the multi-components, multi-targets and multi-channels mechanism of Zuomua Decoction in the treatment of hypertension based on network pharmacology and molecular docking technology. First of all, the chemical components of Zuomua Decoction were obtained in the retrieval of traditional Chinese medicine systems pharmacology database(TCMSP), China National Knowledge Infrastructure(CNKI) and Wanfang database. The potential targets of Zuomua Decoction were predicted by BATMAN-TCM database, and the targets of hypertension were obtained by using DisGeNET database. The intersection of these two targets set was taken to obtain the potential targets of Zuomua Decoction in the treatment of hypertension, and then the chemical compositions-targets network was constructed. Secondly, the intersection targets were imported into STRING database to obtain the interaction relationship of intersection targets, and the protein interaction network of Zuomua Decoction in the treatment of hypertension was constructed in Cytoscape. Topological, GO, and KEGG enrichment analysis were used to construct the key targets-signal pathways-biological processes network diagram and explore the mechanism of Zuomua Decoction in the treatment of hypertension. Finally, the key targets were selected to construct the pharmacodynamic identification models to verify the effect mode of Zomua Decoction in treating hypertension. The results showed that there were 61 chemical components and 90 potential targets in the compounds-targets network. We obtained 21 key targets, 154 signal pathways, and 382 biological processes in topological, GO, and KEGG enrichment analysis of the protein interaction network, and in the comprehensive analysis, it was found that Zuomua Decoction could reduce blood pressure by regulating renin angiotension aldosterone system, balancing the concentration of intracellular calcium and sodium ions and regulating vasoconstriction and relaxation. ACE, AGTR1, and ADRB2 were used as the carriers for molecular docking study on the components of Zuoma Decoction, and the results showed that the chemical components of Zuomua Decoction had a good binding activity with key targets. The purpose of this study is to provide ideas for the in-depth study of Zuoma Decoction in the treatment of hypertension, and provide scientific basis for its clinical rational application.


Asunto(s)
Medicamentos Herbarios Chinos , Hipertensión , Antihipertensivos , China , Humanos , Hipertensión/tratamiento farmacológico , Medicina Tradicional Tibetana , Simulación del Acoplamiento Molecular , Tecnología
15.
Zhongguo Zhong Yao Za Zhi ; 45(22): 5393-5402, 2020 Nov.
Artículo en Chino | MEDLINE | ID: mdl-33350198

RESUMEN

This study aimed to explore the optimal indications and mechanism of Uncariae Ramulus cum Uncis(UR)-Eucommiae Cortex(EC) in lowering blood pressure based on network pharmacology and molecular docking. Chemical constituents were collected and screened by TCMSP database. Swiss Target Prediction platform was used to predict the related targets of the drug. OMIM, TCMIP and GeneCards databases were used to collect hypertension-related genes, and the intersections were taken to obtain potential targets for anti-hypertensive treatment of UR-EC. FunRich software was used to enrich the clinical phenotype and expression site of potential target of lowering blood pressure to analyze and predict the optimal indications of UR-EC. STRING database was used for KEGG pathway enrichment analysis, and Cytoscape 3.7.2 was used to construct the network of "composition-target-pathway". The key targets and their corresponding components in the network were analyzed and obtained, and then molecular docking was applied for preliminary verification. Twenty potential active components of UR and 24 potential active components of EC were respectively collected, and 92 anti-hypertensive potential targets of UR-EC were obtained. According to FunRich enrichment results, the optimal indication of UR-EC was pregnancy hypertension, which involved calcium signaling pathway, HIF-1 signaling pathway, neuroactive ligand receptor interaction, renin vascular tightening, VEGF signaling pathway, etc. In addition, AKT1, NOS2, ADRB2, F2, NOS3, SCN5 A, HTR2 A and JAK2 were considered as the key targets in the network. The molecular docking results showed that the screened potential active components had high binding activity with the key targets. This study preliminarily revealed that UR-EC may have therapeutic effects on pregnancy hypertension in terms of sedation, anti-hypertension, anti-inflammatory, anti-oxidation, improvement of vascular endothelial function and so on.


Asunto(s)
Medicamentos Herbarios Chinos , Hipertensión , Medicamentos Herbarios Chinos/farmacología , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/genética , Medicina China Tradicional , Simulación del Acoplamiento Molecular , Embarazo
16.
Harefuah ; 159(12): 887-891, 2020 Dec.
Artículo en Hebreo | MEDLINE | ID: mdl-33369304

RESUMEN

BACKGROUND: The possible link between hypertension and chronic kidney disease has been preoccupying the medical world for over a century. The cause-effect relationship between malignant hypertension and renal disease is clear and agreed upon, but when hypertension is at milder levels, this relationship becomes blurred. Does indeed non-malignant hypertension also cause kidney disease that can lead to end-stage kidney failure? In this review, we provide evidence based primarily on epidemiologic data, from which it can be concluded that the higher the blood pressure is, starting from normal blood pressure and above, the higher is the risk of developing kidney disease and loss of renal function. Does treatment of hypertension prevent kidney injury secondary to hypertension? The evidence points to the issue that hypertension slows down the rate of decline in glomerular filtration rate, but only in the presence of significant urinary protein excretion, whereas in the absence of proteinuria, lowering blood pressure has no effect on the development of hypertensive renal disease.


Asunto(s)
Antihipertensivos , Hipertensión , Antihipertensivos/uso terapéutico , Presión Sanguínea , Tasa de Filtración Glomerular , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Hipertensión/etiología , Proteinuria/epidemiología , Proteinuria/etiología
17.
Eur Heart J ; 41(48): 4580-4588, 2020 12 21.
Artículo en Inglés | MEDLINE | ID: mdl-33206176

RESUMEN

AIMS: Angiotensin-converting enzyme 2 (ACE2) is the cellular entry point for severe acute respiratory syndrome coronavirus (SARS-CoV-2)-the cause of coronavirus disease 2019 (COVID-19). However, the effect of renin-angiotensin system (RAS)-inhibition on ACE2 expression in human tissues of key relevance to blood pressure regulation and COVID-19 infection has not previously been reported. METHODS AND RESULTS: We examined how hypertension, its major metabolic co-phenotypes, and antihypertensive medications relate to ACE2 renal expression using information from up to 436 patients whose kidney transcriptomes were characterized by RNA-sequencing. We further validated some of the key observations in other human tissues and/or a controlled experimental model. Our data reveal increasing expression of ACE2 with age in both human lungs and the kidney. We show no association between renal expression of ACE2 and either hypertension or common types of RAS inhibiting drugs. We demonstrate that renal abundance of ACE2 is positively associated with a biochemical index of kidney function and show a strong enrichment for genes responsible for kidney health and disease in ACE2 co-expression analysis. CONCLUSION: Our results indicate that neither hypertension nor antihypertensive treatment is likely to alter the expression of the key entry receptor for SARS-CoV-2 in the human kidney. Our data further suggest that in the absence of SARS-CoV-2 infection, kidney ACE2 is most likely nephro-protective but the age-related increase in its expression within lungs and kidneys may be relevant to the risk of SARS-CoV-2 infection.


Asunto(s)
/genética , Antihipertensivos/farmacología , Hipertensión , Túbulos Renales/metabolismo , Pulmón/metabolismo , Sistema Renina-Angiotensina/efectos de los fármacos , Antagonistas Adrenérgicos beta/farmacología , Adulto , Factores de Edad , Anciano , Antagonistas de Receptores de Angiotensina/farmacología , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Animales , Diuréticos/farmacología , Femenino , Perfilación de la Expresión Génica , Tasa de Filtración Glomerular , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/genética , Túbulos Renales/fisiopatología , Masculino , Persona de Mediana Edad , Ratas , Ratas Endogámicas SHR , Análisis de Secuencia de ARN , Factores Sexuales , Transcriptoma/efectos de los fármacos
18.
PLoS One ; 15(11): e0242429, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33211759

RESUMEN

Elevated Renal cell carcinoma (RCC) risk has been associated with the use of several antihypertensive medications but has not yet been elucidated in the populations prescribed alpha-1 blockers that are commonly used in the treatment of hypertension and lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS-BPH). The aim of the present study was to investigate the association between alpha-1 blocker use and the risk of developing RCC using a nationwide population-based database in Taiwan. Patients who were treated with alpha-1 blockers for at least 28 days were identified through the Taiwan National Health Insurance Research Database from 2000 to 2010. The unexposed participants were matched with the exposed cases according to age, sex, and index year at a ratio of 3:1. Cox proportional hazards regression, stratified by sex and comorbidities and adjusted for age, was performed to estimate hazard ratios (HRs) for the risk of subsequent RCC. Among 2,232,092 subjects, patients who received alpha-1 blocker treatment had a higher risk of RCC than the unexposed group. Taking into account hypertension and BPH, the adjusted HR was significantly higher in male alpha-1 blocker users who had no BPH and either the presence (HR: 1.63, 95% confidence interval [CI] = 1.22-2.18) or absence (HR: 2.31, 95% CI = 1.40-3.81) of hypertension than in men not receiving these drugs. Taken together, male alpha-1 blocker users who had no comorbidity of BPH exhibited an increased risk for developing RCC independent of hypertension. Further study is warranted to elucidate the underlying mechanisms of this association.


Asunto(s)
Antagonistas de Receptores Adrenérgicos alfa 1/efectos adversos , Carcinoma de Células Renales/inducido químicamente , Neoplasias Renales/inducido químicamente , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapéutico , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Neoplasias Renales/epidemiología , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Hiperplasia Prostática/tratamiento farmacológico , Hiperplasia Prostática/epidemiología , Estudios Retrospectivos , Riesgo , Distribución por Sexo , Taiwán/epidemiología
19.
Kardiologiia ; 60(10): 132-140, 2020 Nov 12.
Artículo en Ruso | MEDLINE | ID: mdl-33228516

RESUMEN

Arterial hypertension (AH) and exertional headache (EHA) are comorbidities. The article presents a nonsystematic review focused on studying the AH+EHA phenotype. The authors addressed the history of studying the phenotype, several theories about its pathophysiological causes (psychosomatic, neuroanatomical, and baroreflector). The protective "hypertension-associated hypoalgesia" phenotype, a mechanism of its change in AH chronization, and difficulties of differential diagnosis are described. The AH+EHA phenotype requires further study since its incidence is quite high. This will allow developing an individualized approach in prevention and treatment of EHA attacks, decreasing the risk of life-threatening cardiovascular complications, and avoiding iatrogenic complications in patients with AH. The main way to prevent the development of AH+EHA phenotype is patient's compliance, which can be provided by using combination hypotensive drugs to reduce the number of pills and dosing. It is important to take into account possible adverse reactions of the nervous system (medication-overuse headache or EHA aggravation). Considering these conditions, the drug Triplixam can be used for prevention of complications in the AH+EHA phenotype. Triplixam is a fixed triple combination of amlodipine/indapamide/perindopril, and its individual components have low and medium risk for development of headache.


Asunto(s)
Hipertensión , Indapamida , Cefalea de Tipo Tensional , Amlodipino/farmacología , Antihipertensivos/uso terapéutico , Presión Sanguínea , Comorbilidad , Combinación de Medicamentos , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Perindopril/farmacología , Cefalea de Tipo Tensional/tratamiento farmacológico , Cefalea de Tipo Tensional/epidemiología
20.
Zhongguo Zhong Yao Za Zhi ; 45(17): 4246-4253, 2020 Sep.
Artículo en Chino | MEDLINE | ID: mdl-33164410

RESUMEN

To explore the effect of Xiaoji Recipe on the stability of carotid artery vulnerable plaque in elderly patients with type 2 diabetes mellitus and type H hypertension(Qi-Yin deficiency with phlegm stagnation). From January 2017 to April 2019, in Endocrinology Department for Outpatients and Inpatients of the First Affiliated Hospital of Henan University of Chinese Medicine, 125 elderly patients with type 2 diabetes mellitus and type H hypertension with carotid artery vulnerable plaque(Qi-Yin deficiency with phlegm stagnation) were selected. According to the numerical table method, the patients were randomly divided into the control group(63 cases, including 56 cases completed) and Xiaoji group(62 cases, including 58 cases completed). Both groups were given control diet, hypoglycemic, hypotensive and symptomatic therapies. The control group was given Rosuvastatin Calcium Tablets 20 mg·d~(-1) before sleep. The Xiaojie group were given Ruisuvastatin Calcium Tablets 10 mg·d~(-1) before sleep, plus Xiaoji Recipe at the same time. Both groups were treated for 6 months. The number of vulnerable plaques, carotid intima-media thickness(IMT) and plaque thickness were detected by color Doppler ultrasound before and after treatment, in order to calculate IMT integral and improved Crouse integral. Meanwhile, lipid metabolism indexes, including total cholesterol(TC), triacylglycerol(TG), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C) and lipoprotein a(LPa). And plaque stability indexes, including hypersensitive c-reactive protein(hs-CRP), matrix metalloproteinase-9(MMP-9), oxidized low-density lipoprotein(ox-LDL), Ⅰ type platelet depolymerization protein binding protein base sequence of metalloproteinases(ADAMTS-Ⅰ) and homocysteine(Hcy) were detected. To evaluate the 6-month curative effect on TCM syndrome, the patients were followed up for 6 months for adverse cardiovascular and cerebrovascular events and adverse drug reactions. After 6 months of treatment, the efficacy on Xiaoji group was better than that of the control group(Z=-2.600, P=0.009). The significant efficiency of the Xiaoji group was higher than that of the control group(χ~2=6.039, P=0.014). The total effective rate of the Xiaoji group was higher than that of the control group(χ~2=4.564, P=0.033). The number of vulnerable plaques form indexes(IMT, IMT integral, plaque thickness, improved Crouse integral), blood lipid metabolism indexes(TC, TG, LDL-C, HDL-C, LPa) and plaque stability indexes(hs-CRP, MMP-9, ox-LDL, ADAMTS-Ⅰ, Hcy) were significantly improved than before treatment in both groups of patients(P<0.01). Compared with the control group, the Xiaoji group showed more obvious improvement(P<0.01). The incidence of adverse cardiovascular and cerebrovascular events in the Xiaoji group was lower than that in the control group within 6 months after treatment(χ~2=4.566, P=0.033). The incidence of adverse drug reactions in the Xiaoji group was lower than that in the control group(χ~2=4.465, P=0.035). This indicated that Xiaoji Recipe combined with small-dose Rosuvastatin Calcium(10 mg·d~(-1)) was safe and effective in the treatment of elderly patients of type 2 diabetes mellitus with type H hypertension and vulnerable carotid artery plaque(Qi-Yin deficiency with phlegm stagnation), and superior to the single high-dose Risovastatin Calcium(20 mg·d~(-1)) regimen. It can reverse carotid plaque, and reduce the activity of vulnerable plaque and the incidence of adverse cardiovascular and cerebrovascular events and adverse drug reactions.


Asunto(s)
Estenosis Carotídea , Diabetes Mellitus Tipo 2 , Hipertensión , Anciano , Arterias Carótidas/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Medicamentos Herbarios Chinos , Humanos , Hipertensión/tratamiento farmacológico
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