Temporal changes in antihypertensive prescribing trend in Bahrain over a decade: emerging issues in iatrogenic sexual dysfunction.

OBJECTIVE: To elucidate temporality of antihypertensive drug prescribing trends over a decade in terms of emerging views on iatrogenic sexual dysfunctions (SD). METHODS: The antihypertensive prescribing trend in 2007 was compared with baseline data collected in 1998 using prescription audit. RESULTS: Angiotensin converting enzyme (ACE) inhibitors were deemed first and second ranked antihypertensives for patients with diabetic hypertension and hypertension in 2007, respectively. Between 1998 and 2007 ß-blockers such as atenolol, and methyldopa use has declined in both male and female patients. In 2007, the rate of prescribing atenolol at inappropriately high doses has declined as compared to 1998, especially in males. Methyldopa overall use has declined in 2007, although it is often prescribed to females. Compared to baseline of 1998 there was a significant upturn in diuretic use. Nonetheless the trend towards prescribing indapamide ≤ 1.5 mg/day and 12.5 mg/day hydrochlorothiazide, at doses least likely to cause SD, was evident in both male and females. This trend appears to be related to the use of fixed-dose combinations (FDCs) and antihypertensive combination therapies which have significantly increased in recent years (p < 0.0001). CONCLUSION: With respect to the prescribing rate and dose appropriateness, antihypertensives that are likely to cause SD appear to be more rationally prescribed in 2007 as compared to 1998. Introducing FDCs had an important role in resurgence of appropriate low dose of drugs implicated with SD and diuretic-based antihypertensive combination therapies.

Drug information, misinformation, and disinformation on social media: a content analysis study.

Dissemination of misleading drug information through social media can be detrimental to the health of the public. This study, carried out in Bahrain, evaluated the truthfulness of 22 social media claims about drugs (72.7%), dietary supplements (22.7%), and toxic bisphenol-A (4.5%). They circulated on WhatsApp platform, as case studies. We categorized claims as objectively true, false, or potentially misleading. The content analysis revealed that "potentially misleading" claims were the most frequent messages (59.1%). They tend to exaggerate the efficacy or safety without sufficient evidence to substantiate claims. False claims (27.3%) were likely due to unfair competition or deception. Overall, 13.6% of the messages were objectively true claims that could withstand regulatory scrutiny. Majority of the drug-related messages on social media were potentially misleading or false claims that lacked credible evidence to support them. In the public interest, regulatory authorities should monitor such information disseminated via social media platforms.

Antihypertensive Drugs and Male Sexual Dysfunction: A Review of Adult Hypertension Guideline Recommendations.

BACKGROUND: Published clinical practice guidelines have addressed antihypertensive therapy and sexual dysfunction (SD) in many different ways. OBJECTIVE: In this systematic review, we evaluated guidelines that address antihypertensive drug-associated SD, guideline recommendations, and recent guideline trends. METHODS: Thirty sets of guidelines for hypertension management in adults that had been published in the English language since 2000 were reviewed. The primary outcome measure was antihypertensive-associated SD potential, which was independently evaluated using specific questions by 2 authors in a nonblinded standardized manner. RESULTS: Sexual dysfunctions associated with thiazide-class diuretics, ß-blockers, and centrally acting sympathoplegics were addressed by half of the guidelines reviewed. There is no clarity on ß-blockers and thiazide-class diuretics because one-third of the guidelines are vague about individual ß-blockers and diuretics, and there is no statement on third-generation ß-blockers and thiazide-like diuretics that can improve erectile function. The revised guidelines never use terms such as loss of libido, ejaculatory dysfunction, lack of orgasm, and priapism. Summary versions of guidelines are inadequate to reflect the key interpretation of the primary guidelines on SD associated with antihypertensives, even in the major guidelines that were updated recently. Therapeutic issues such as exploring SD in clinical history, assessing SD prior to and during treatment with antihypertensives, substituting the offending agents with alternatives that possess a better safety profile, intervening with phosphodiesterase-5 inhibitors, and avoiding the concomitant use of nitrovasodilators are superficially addressed by most guidelines, with the exception of 2013 European Society of Hypertension/European Society of Cardiology and Seventh Joint National Committee recommendations. CONCLUSION: Future guideline revisions, including both full and summary reports, should provide a balanced perspective on antihypertensive-related SD issues to improve the impact of hypertension treatment guidelines on patient care and quality of life.

Drug treatment of hypertension in pregnancy: a critical review of adult guideline recommendations.

This review evaluates the guideline recommendations for the management of hypertension in pregnancy as presented by 25 national/international guidelines developed for the management of arterial hypertension in adults. There is a general consensus that oral α-methyldopa and parenteral labetalol are the drugs of choice for nonsevere and severe hypertension in pregnancy, respectively. Long-acting nifedipine is recommended by various guidelines as an alternative for first-line and second-line therapy in nonsevere and severe hypertension. The safety of ß-blockers, atenolol in particular, in early and late stages of pregnancy is unresolved; their use is contraindicated according to several guidelines. Diuretic-associated harmful effects on maternal and fetal outcomes are controversial: their use is discouraged in pregnancy. It is important to develop specific guidelines for treating hypertension in special groups such as adult females of childbearing age and sexually active female adolescents to minimize the risk of adverse effects of drugs on the fetus. In several guidelines, the antihypertensive classes, recommended drug(s), intended drug formulation, and route of administration are not explicit. These omissions should be addressed in future guideline revisions in order to enhance the guidelines' utility and credibility in clinical practice.

MINOS1 is a conserved component of mitofilin complexes and required for mitochondrial function and cristae organization.

The inner membrane of mitochondria is especially protein rich and displays a unique morphology characterized by large invaginations, the mitochondrial cristae, and the inner boundary membrane, which is in proximity to the outer membrane. Mitochondrial inner membrane proteins appear to be not evenly distributed in the inner membrane, but instead organize into functionally distinct subcompartments. It is unknown how the organization of the inner membrane is achieved. We identified MINOS1/MIO10 (C1orf151/YCL057C-A), a conserved mitochondrial inner membrane protein. mio10-mutant yeast cells are affected in growth on nonfermentable carbon sources and exhibit altered mitochondrial morphology. At the ultrastructural level, mutant mitochondria display loss of inner membrane organization. Proteomic analyses reveal MINOS1/Mio10 as a novel constituent of Mitofilin/Fcj1 complexes in human and yeast mitochondria. Thus our analyses reveal new insight into the composition of the mitochondrial inner membrane organizing machinery.