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Aldosterone antagonist

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https://www.readbyqxmd.com/read/28619367/the-vasoprotective-axes-of-the-renin-angiotensin-system-physiological-relevance-and-therapeutic-implications-in-cardiovascular-hypertensive-and-kidney-diseases
#1
REVIEW
Xiao C Li, Jianfeng Zhang, Jia L Zhuo
The renin-angiotensin system (RAS) is undisputedly one of the most prominent endocrine (tissue-to-tissue), paracrine (cell-to-cell) and intracrine (intracellular/nuclear) vasoactive systems in the physiological regulation of neural, cardiovascular, blood pressure, and kidney function. The importance of the RAS in the development and pathogenesis of cardiovascular, hypertensive and kidney diseases has now been firmly established in clinical trials and practice using renin inhibitors, angiotensin-converting enzyme (ACE) inhibitors, type 1 (AT1) angiotensin II (ANG II) receptor blockers (ARBs), or aldosterone receptor antagonists as major therapeutic drugs...
June 12, 2017: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/28618427/matrix-metalloproteases-in-arterial-hypertension-and-their-trend-after-antihypertensive-treatment
#2
Eugenia Hopps, Rosalia Lo Presti, Gregorio Caimi
BACKGROUND/AIMS: Arterial hypertension is characterized by vascular remodelling, atherosclerosis and cardiovascular complications. Matrix metalloproteases (MPPs) are endopeptidases produced by all the cells present in the vascular wall and are involved in the regulation of the extracellular matrix protein turnover. MMPs contribute to blood vessel formation, remodelling, angiogenesis; whereas an altered expression or activity of MMPs or their tissue inhibitors (TIMPs) results correlated with the development and progression of cardiovascular complications...
2017: Kidney & Blood Pressure Research
https://www.readbyqxmd.com/read/28602369/heart-failure-complicating-acute-mtyocardial-infarction
#3
REVIEW
Wilbert S Aronow
Factors predisposing the older person with acute myocardial infarction (MI) to develop heart failure (HF) include an increased prevalence of MI, multivessel coronary artery disease, decreased left ventricular (LV) contractile reserve, impairment of LV diastolic relaxation, increased hypertension, LV hypertrophy, diabetes mellitus, valvular heart disease, and renal insufficiency. HF associated with acute MI should be treated with a loop diuretic. The use of nitrates, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, aldosterone antagonists, beta-blockers, digoxin, and positive inotropic drugs; treatment of arrhythmias and mechanical complications; and indications for use of implantable cardioverter-defibrillators and cardiac resynchronization is discussed...
July 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/28597606/the-mortality-risk-of-deferring-optimal-medical-therapy-in-heart-failure-a-systematic-comparison-against-norms-for-surgical-consent-and-patient-information-leaflets
#4
Sameer Zaman, Saman S Zaman, Timothy Scholtes, Matthew J Shun-Shin, Carla M Plymen, Darrel P Francis, Graham D Cole
AIMS: The prescription of optimal medical therapy for heart failure is often delayed despite compelling evidence of a reduction in mortality. We calculated the absolute risk resulting from delayed prescription of therapy. For comparison, we established the threshold applied by clinicians when discussing the risk for death associated with an intervention, and the threshold used in official patient information leaflets. METHODS AND RESULTS: We undertook a meta-analysis of randomized controlled trials to calculate the excess mortality caused by deferral of medical therapy for 1 year...
June 8, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28597403/resistant-hypertension-mechanisms-and-treatment
#5
REVIEW
Andrew Y Hwang, Eric Dietrich, Carl J Pepine, Steven M Smith
PURPOSE OF REVIEW: Emerging evidence suggests that multiple mechanisms may be responsible for the development of treatment-resistant hypertension (TRH). This review aims to summarize recent data on potential mechanisms of resistance and discuss current pharmacotherapeutic options available in the management of TRH. RECENT FINDINGS: Excess sodium and fluid retention, increased activation of the renin-angiotensin-aldosterone system, and heightened activity of the sympathetic nervous system appear to play an important role in development of TRH...
July 2017: Current Hypertension Reports
https://www.readbyqxmd.com/read/28584012/nefm-neurofilament-medium-polypeptide-a-marker-for-zona-glomerulosa-cells-in-human-adrenal-inhibits-d1r-dopamine-d1-receptor-mediated-secretion-of-aldosterone
#6
Carmela Maniero, Sumedha Garg, Wanfeng Zhao, Timothy Isaac Johnson, Junhua Zhou, Mark Gurnell, Morris J Brown
Heterogeneity among aldosterone-producing adenomas (APAs) has been highlighted by the discovery of somatic mutations. KCNJ5 mutations predominate in large zona fasciculata (ZF)-like APAs; mutations in CACNA1D, ATP1A1, ATP2B3, and CTNNB1 are more likely to be found in small zona glomerulosa (ZG)-like APAs. Microarray comparison of KCNJ5 mutant versus wild-type APAs revealed significant differences in transcriptomes. NEFM, encoding a neurofilament subunit which is a D1R (dopamine D1 receptor)-interacting protein, was 4-fold upregulated in ZG-like versus ZF-like APAs and 14-fold more highly expressed in normal ZG versus ZF...
June 5, 2017: Hypertension
https://www.readbyqxmd.com/read/28580623/the-relationship-of-circulating-relaxin-2-concentrations-with-short-term-prognosis-in-patients-with-acute-heart-failure-the-relahf-study
#7
Pablo Herrero-Puente, Belén Prieto-García, María García-García, Pere Llorens, Francisco Javier Martín-Sánchez, Javier Jacob, Alexandre Mebazaa, Christian Mueller, Alan S Maisel, Víctor Gil, Pablo García-Hernandez, Òscar Miró
AIMS: This study aimed to determine the frequency of detectable relaxin-2 concentrations and associated factors in patients with acute heart failure (AHF) and to establish relationships with short-term outcome and clinical and analytical parameters. METHODS AND RESULTS: We performed a prospective, analytical, observational, multicentre study with cohort follow-up. We collected sociodemographic variables, previous history, basal status, previous treatment, vital signs, electrocardiographic and analytical data in the emergency department...
June 5, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28573538/nutritional-screening-based-on-the-controlling-nutritional-status-conut-score-at-the-time-of-admission-is-useful-for-long-term-prognostic-prediction-in-patients-with-heart-failure-requiring-hospitalization
#8
Isao Nishi, Yoshihiro Seo, Yoshie Hamada-Harimura, Kimi Sato, Seika Sai, Masayoshi Yamamoto, Tomoko Ishizu, Akinori Sugano, Kenichi Obara, Longmei Wu, Shoji Suzuki, Akira Koike, Kazutaka Aonuma
The objective of the study was to clarify whether controlling nutritional status (CONUT) is useful for predicting the long-term prognosis of patients hospitalized with heart failure (HF). A total of 482 (57.5%) HF patients from the Ibaraki Cardiovascular Assessment Study-HF (N = 838) were enrolled (298 men, 71.7 ± 13.6 years). At admission, blood samples were collected and nutritional status assessed using CONUT. CONUT scores were defined as follows: 0-1, normal; 2-4, light; 5-8, moderate; and 9-12, severe undernutrition...
June 1, 2017: Heart and Vessels
https://www.readbyqxmd.com/read/28567353/differential-efficacy-profile-of-aldosterone-receptor-antagonists-depending-on-the-type-of-chronic-heart-failure-whether-with-reduced-or-preserved-left-ventricular-ejection-fraction-results-of-a-meta-analysis-of-randomized-controlled-trials
#9
Renato De Vecchis, Carmelina Ariano
BACKGROUND: Because of renin-angiotensin-aldosterone system (RAAS) activation, the patients with chronic heart failure (CHF) manifest increased ventricular stress, with impaired left ventricular function, and a slowing down in systemic venous drainage. More importantly, a reduction of the patient's life expectancy has been proven in the case of RAAS overstimulation. For these reasons, huge efforts have been made to obtain molecules able to efficaciously antagonize the RAAS overstimulation, such as aldosterone receptor antagonists (ARAs)...
June 2017: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/28567084/clinical-characteristics-and-outcome-of-acute-heart-failure-in-korea-results-from-the-korean-acute-heart-failure-registry-korahf
#10
Sang Eun Lee, Hae-Young Lee, Hyun-Jai Cho, Won-Seok Choe, Hokon Kim, Jin Oh Choi, Eun-Seok Jeon, Min-Seok Kim, Jae-Joong Kim, Kyung-Kuk Hwang, Shung Chull Chae, Sang Hong Baek, Seok-Min Kang, Dong-Ju Choi, Byung-Su Yoo, Kye Hun Kim, Hyun-Young Park, Myeong-Chan Cho, Byung-Hee Oh
BACKGROUND AND OBJECTIVES: The burden of heart failure has increased in Korea. This registry aims to evaluate demographics, clinical characteristics, management, and long-term outcomes in patients hospitalized for acute heart failure (AHF). SUBJECTS AND METHODS: We prospectively enrolled a total of 5625 consecutive subjects hospitalized for AHF in one of 10 tertiary university hospitals from March 2011 to February 2014. Descriptive statistics were used to determine the baseline characteristics of the study population and to compare them with those from other registries...
May 2017: Korean Circulation Journal
https://www.readbyqxmd.com/read/28565796/hemodynamic-effects-of-renin-angiotensin-aldosterone-inhibitor-and-%C3%AE-blocker-combination-therapy-vs-%C3%AE-blocker-monotherapy-for-portal-hypertension-in-cirrhosis-a-meta-analysis
#11
Jianrong Wang, Wenxia Lu, Jingjing Li, Rong Zhang, Yuqing Zhou, Qin Yin, Yuanyuan Zheng, Fan Wang, Yujing Xia, Kan Chen, Sainan Li, Tong Liu, Jie Lu, Yingqun Zhou, Chuan-Yong Guo
β-blockers are commonly used for the treatment of acute variceal bleeding in cirrhosis. Renin-angiotensin-aldosterone antagonists (angiotensin I-converting enzyme inhibitors, angiotensin receptor blockers and aldosterone antagonists) are potential therapies for portal hypertension. Several studies have compared the renin-angiotensin-aldosterone system (RAAS) inhibitor and β-blocker combination therapy vs. β-blocker monotherapy, with inconsistent results. The aim of the present study was to assess the efficacy of the RAAS inhibitor and β-blocker combination therapy vs...
May 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28545803/impact-of-a-multidisciplinary-heart-failure-postdischarge-management-clinic-on-medication-adherence
#12
Lingyun Lu, Cynthia A Jackevicius, Noelle K de Leon, Alberta L Warner, Donald S Chang, Freny Vaghaiwalla Mody
PURPOSE: Disease management programs have been associated with improved adherence to heart failure (HF) medications. However, there remain limited data on the benefit of a comprehensive multidisciplinary HF postdischarge management (PDM) clinic that promptly follows HF-related hospitalization on evidence-based HF medication adherence. OBJECTIVE: The aim of this study was to evaluate the effects of an HF-PDM clinic on adherence to evidence-based HF medication therapy...
May 22, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28542926/effect-of-spironolactone-on-exercise-tolerance-and-arterial-function-in-older-adults-with-heart-failure-with-preserved-ejection-fraction
#13
Bharathi Upadhya, William G Hundley, Peter H Brubaker, Timothy M Morgan, Kathryn P Stewart, Dalane W Kitzman
OBJECTIVES: To evaluate the effects of an aldosterone antagonist on exercise intolerance in older adults with heart failure and preserved ejection fraction (HFpEF). DESIGN: Randomized, placebo-controlled, double-blind trial. SETTING: Academic medical center, Winston-Salem, North Carolina. PARTICIPANTS: Older adults (N = 80, aged 71 ± 1; 80% female) with stable compensated HFpEF and controlled blood pressure (BP)...
May 19, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28541811/future-drug-discovery-in-renin-angiotensin-aldosterone-system-intervention
#14
Maria Tamargo, Juan Tamargo
Renin-angiotensin-aldosterone system inhibitors (RAASIs), including angiotensin-converting enzyme inhibitors, angiotensin AT1 receptor blockers and mineralocorticoid receptor antagonists (MRAs), are the cornerstone for the treatment of cardiovascular and renal diseases. Areas covered: The authors searched MEDLINE, PubMed and ClinicalTrials.gov to identify eligible full-text English language papers. Herein, the authors discuss AT2-receptor agonists and ACE2/angiotensin-(1-7)/Mas-receptor axis modulators, direct renin inhibitors, brain aminopeptidase A inhibitors, biased AT1R blockers, chymase inhibitors, multitargeted drugs, vaccines and aldosterone receptor antagonists as well as aldosterone synthase inhibitors...
June 9, 2017: Expert Opinion on Drug Discovery
https://www.readbyqxmd.com/read/28540931/hyperkalemia-in-both-surgically-and-medically-treated-patients-with-primary-aldosteronism
#15
N Wada, Y Shibayama, H Umakoshi, T Ichijo, Y Fujii, K Kamemura, T Kai, R Sakamoto, A Ogo, Y Matsuda, T Fukuoka, M Tsuiki, T Suzuki, M Naruse
Hyperkalemia is an important complication of adrenalectomy for patients with primary aldosteronism (PA). The frequency of hyperkalemia after medication using mineralocorticoid receptor antagonists (MRAs) for PA is unclear. The aim of this study is to investigate the frequency and the risk factors of hyperkalemia after surgery and medication for PA. The data of 376 patients with PA registered in a multicentre-collaborative study in Japan, including surgically treated patients (group A; n=142) and medically treated patients with MRAs (group B; n=234) were studied...
May 25, 2017: Journal of Human Hypertension
https://www.readbyqxmd.com/read/28523441/progress-in-the-presence-of-failure-updates-in-chronic-systolic-heart-failure-management
#16
REVIEW
Katie M Murphy, Julie L Rosenthal
The therapeutic heart failure armamentarium has evolved from drugs to transplantation to devices through further understanding of its complex pathophysiology and pathogenesis. Current medications capitalize on our evolving understanding of the sympathetic and renin-angiotensin-aldosterone systems that subsequently promote both beneficial and maladaptive responses that ultimately yield a decrease in cardiac function. Despite these advancements, the prevalence of heart failure continues to rise and carries a significant burden on our patients and health care system...
July 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28520568/endothelin-a-receptor-antagonists-in-diabetic-kidney-disease
#17
Panagiotis I Georgianos, Rajiv Agarwal
PURPOSE OF REVIEW: Despite optimal therapy of diabetic nephropathy with agents blocking the renin-angiotensin-aldosterone system, the residual risk of nephropathy progression to end-stage renal disease (ESRD) remains high. The purpose of this review is to discuss the potential role of endothelin antagonism as a therapeutic tool to reduce residual proteinuria and delay kidney injury progression among patients with diabetic nephropathy. RECENT FINDINGS: Preclinical studies have shown that endothelin receptor antagonists (ERAs) exert proteinuria lowering and nephroprotective actions in experimental models of diabetic nephropathy...
May 17, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28512920/an-audit-of-adherence-to-heart-failure-guidelines-in-an-australian-hospital-a-pharmacist-perspective
#18
Viviane Khalil, Melanie Danninger, Wei Wang, Hanan Khalil
RATIONALE, AIMS, AND OBJECTIVES: The Australian National Heart Foundation Guidelines have been developed to guide clinicians on how to best manage chronic heart failure (CHF) patients according to the current best available evidence. The primary aim of this study is to evaluate the proportion of patients prescribed evidence-based therapy (EBT) for CHF on discharge at this Australian metropolitan hospital and factors affecting its prescribing. The secondary aims are to examine the proportion of patients prescribed EBT on discharge on cardiac wards compared to medical wards and to explore the role of the pharmacist in the management of these patients...
May 17, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28511711/sglt2-inhibitors-a-novel-choice-for-the-combination-therapy-in-diabetic-kidney-disease
#19
REVIEW
Honghong Zou, Baoqin Zhou, Gaosi Xu
Diabetic kidney disease (DKD) is the most common cause of end stage renal disease. The comprehensive management of DKD depends on combined target-therapies for hyperglycemia, hypertension, albuminuria, and hyperlipaemia, etc. Sodium-glucose co-transporter 2 (SGLT2) inhibitors, the most recently developed oral hypoglycemic agents acted on renal proximal tubules, suppress glucose reabsorption and increase urinary glucose excretion. Besides improvements in glycemic control, they presented excellent performances in direct renoprotective effects and the cardiovascular (CV) safety by decreasing albuminuria and the independent CV risk factors such as body weight and blood pressure, etc...
May 16, 2017: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/28509722/rationale-for-nebivolol-valsartan-combination-for-hypertension-review-of-preclinical-and-clinical-data
#20
Thomas D Giles, John R Cockcroft, Bertram Pitt, Abhijeet Jakate, Harold M Wright
: To treat hypertension, combining two or more antihypertensive drugs from different classes is often necessary. β-Blockers and renin-angiotensin-aldosterone system inhibitors, when combined, have been deemed 'less effective' based on partially overlapping mechanisms of action and limited evidence. Recently, the single-pill combination (SPC) of nebivolol (Neb) 5 mg - a vasodilatory β1-selective antagonist/β3 agonist - and valsartan 80 mg, an angiotensin II receptor blocker, was US Food and Drug Administration-approved for hypertension...
May 15, 2017: Journal of Hypertension
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