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Hamish C G Prosser, Omar Azzam, Markus P Schlaich
Resistant hypertension is commonly defined as office blood pressure above recommended target despite the use of optimal doses of at least three antihypertensive drugs including a diuretic. Australian guidelines recommend combination of blockers of the renin-angiotensin system, either ACE inhibitors or angiotensin receptor blockers, with calcium channel blockers and diuretics as the preferred triple therapy. A substantial proportion of hypertensive patients will require additional pharmacotherapy to achieve or get close to target blood pressure levels...
March 1, 2018: Heart, Lung & Circulation
Frank Edelmann, Christoph Knosalla, Klaus Mörike, Christiane Muth, Peggy Prien, Stefan Störk
BACKGROUND: Chronic heart failure (CHF) is the most common reason for hospital admissions in Germany. For the National Disease Management Guideline (NDMG) on CHF, a multidisciplinary expert panel revised the chapters on drug therapy, invasive therapy, and care coordination, following the methods of evidence-based medicine. METHODS: Recommendations are based on international guideline adaptations or systematic literature search. They were developed by a multidisciplinary expert panel, approved in a formal consensus procedure, and tested in open consultation, as specified by the requirements for S3 guidelines...
February 23, 2018: Deutsches Ärzteblatt International
B Wilkins, S Hullikunte, M Simmonds, A Sasse, P D Larsen, S A Harding
BACKGROUND: We assessed the effect of a pre-discharge medication checklist on discharge prescription rates of guideline recommended medications following myocardial infarction. In addition, we assessed what proportion of the residual prescribing gap following implementation of the checklist was due to the presence of contraindications. METHODS: We examined baseline prescription rates of guideline recommended medications in 100 patients discharged from our institution following acute myocardial infarction...
November 14, 2017: Heart, Lung & Circulation
William King, Arron Lacey, James White, Daniel Farewell, Frank Dunstan, David Fone
BACKGROUND: Coronary heart disease (CHD) mortality in England fell by 36% between 2000 and 2007 and it is estimated that approximately 50% of the fall was due to improved treatment uptake. Marked socio-economic inequalities in CHD mortality in the United Kingdom (UK) remain, with higher age-adjusted rates in more deprived groups. Inequalities in the persistence of medication for primary and secondary prevention of CHD may contribute to the observed social gradient and we investigated this possibility in the population of Wales (UK)...
2018: PloS One
Ioannis E Vasileiadis, Christos A Goudis, Pinelopi T Giannakopoulou, Tong Liu
Chronic obstructive pulmonary disease (COPD) is a complex disorder that primarily affects the lungs and is characterized not only by local pulmonary, but also by systemic inflammation which promotes the development of extrapulmonary and cardiovascular co-morbidities. Angiotensin converting enzyme (ACE) inhibitors and ARBs (angiotensin receptor blockers) are widely used drugs in the treatment of cardiovascular diseases, with growing evidence suggesting potential benefits in COPD patients. The purpose of this review is to describe the correlation of renin-angiotensin system (RAS) with COPD pathophysiology and to present the latest data regarding the potential role of RAS blockers in COPD...
March 9, 2018: COPD
Ali Valika, Kim Paprockas, Dana Villines, Maria Rosa Costanzo
BACKGROUND: Left ventricular ejection fraction (LVEF) has shown to predict outcomes in patients with heart failure (HF). Left ventricular recovery (LVR) has shown to improve prognosis. HYPOTHESIS: Guideline directed medical therapy (GDMT) will predict LVR in patients with HF and reduced EF. METHODS: 244 patients with newly diagnosed HF and a LVEF ≤ 35% were studied. LVR was defined as an increase in LVEF ≥ 40%. Patients who experienced LVR were compared to those who had persistent left ventricular dysfunction (LVD)...
March 7, 2018: Clinical Cardiology
Jennifer Sjaarda, Hertzel C Gerstein, Salim Yusuf, Darin Treleaven, Michael Walsh, Johannes F E Mann, Sibylle Hess, Guillaume Paré
Many biomarkers have been epidemiologically linked with CKD; however, the possibility that such associations are due to reverse causation or confounding limits the utility of these biomarkers. To overcome this limitation, we used a Mendelian randomization (MR) approach to identify causal mediators of CKD. We performed MR by first identifying genetic determinants of 227 serum protein biomarkers assayed in 4147 participants of the Outcome Reduction with Initial Glargine Intervention (ORIGIN) trial who had early or prediabetes, and assessing the effects of these biomarkers on CKD in the CKD genetics consortium ( n =117,165; 12,385 cases) using the inverse-variance weighted (fixed-effects) method...
March 6, 2018: Journal of the American Society of Nephrology: JASN
Hanmanth Reddy Vulupala, Yasodakrishna Sajja, Pankaj K Bagul, Raviteja Bandla, Lingaiah Nagarapu, Sanjay K Benerjee
A novel triazole derivatives(±)-2-(hydroxymethyl)-7,8-dihydro-1H-indeno[5,4-b]furan-6(2H)-one (12a-j) were designed and synthesized by the reaction between racemic azide and terminal acetylenes under click chemistry reaction conditions followed by biological evaluation as angiotensin converting enzyme (ACE) inhibitors. β-Amino alcohol derivatives of 1-indanone (15a-l) were synthesized from 5-hydroxy indanone, it was reacted with epichlorohydrin and followed by oxirane ring opening with various piperazine derivatives...
February 24, 2018: Bioorganic Chemistry
Jiří Slíva
Thiazide and thiazide-like diuretics are an important group of drugs used in the treatment of essential arterial hyper-tension. While their beneficial therapeutic effect in monotherapy is evident, they are increasingly used in fixed combinations, particularly with ACE inhibitors or sartans. The aim of this article was to summarize the current status of hydrochlorothiazide and compare its effects with other substances in this subgroup of diuretics.Key words: diuretics - HCTZ - hydrochlorothiazide - hypertension - chlorthalidone - indapamide - thiazide...
2018: Vnitr̆ní Lékar̆ství
Nathalie Donis, Cécile Oury, Marie Moonen, Patrizio Lancellotti
Available data indicate that survivors of breast cancer and Hodgkin lymphoma who received mediastinal radiotherapy are at increased risk of developing radiation-induced cardiovascular diseases (RICVD) one or two decades after treatment. Although the risk with modern radiation treatment is likely to be lower in these patient groups, cardiotoxicity is still observed in a subset of patients. In addition, radiation-associated cardiovascular complications can, in the future, extend to other groups of cancer patients who are treated for tumors that are localized near the heart...
March 1, 2018: Expert Opinion on Pharmacotherapy
C J Michaud, Brian Trethowan
When aortic dissections extend to the renal arteries, the reductions in renal blood flow can cause marked increases in renin production. The resultant rise in angiotensin II can lead to difficult-to-control blood pressure, despite normal post-dissection antihypertensive agents. Herein, we highlight a case of a post-dissection patient with malignant hypertension refractory to eight different enteral antihypertensives. Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers had been held due to post-operative acute kidney injury...
February 28, 2018: Pharmacotherapy
Riley D Bowers, Sara M Valanejad, Ashley A Holombo
Acute pancreatitis has numerous etiologies, with the most common including gallstones, alcohol abuse, and medications such as angiotensin-converting enzyme (ACE) inhibitors, statins, and diuretics. Mirtazapine has been associated with increased serum cholesterol and serum triglyceride levels. However, few studies have reported dangerously elevated triglyceride levels resulting in acute pancreatitis. This report discusses a case of mirtazapine-induced pancreatitis in a 46-year-old African American female. The patient presented to the emergency department with pancreatitis, presumably alcohol-induced as with a prior admission, but she denied any recent alcohol use...
January 1, 2018: Journal of Pharmacy Practice
Sergei M Danilov, Victoria E Tikhomirova, Roman Metzger, Irina A Naperova, Tatiana M Bukina, Ozlem Goker-Alpan, Nahid Tayebi, Nurshat M Gayfullin, David E Schwartz, Larisa M Samokhodskaya, Olga A Kost, Ellen Sidransky
BACKGROUND: Gaucher disease is characterized by the activation of splenic and hepatic macrophages, accompanied by dramatically increased levels of angiotensin-converting enzyme (ACE). To evaluate the source of the elevated blood ACE, we performed complete ACE phenotyping using blood, spleen and liver samples from patients with Gaucher disease and controls. METHODS: ACE phenotyping included 1) immunohistochemical staining for ACE; 2) measuring ACE activity with two substrates (HHL and ZPHL); 3) calculating the ratio of the rates of substrate hydrolysis (ZPHL/HHL ratio); 4) assessing the conformational fingerprint of ACE by evaluating the pattern of binding of monoclonal antibodies to 16 different ACE epitopes...
February 17, 2018: Molecular Genetics and Metabolism
David Julian McClements
There are many examples of bioactive proteins and peptides that would benefit from oral delivery through functional foods, supplements, or medical foods, including hormones, enzymes, antimicrobials, vaccines, and ACE inhibitors. However, many of these bioactive proteins are highly susceptible to denaturation, aggregation or hydrolysis within commercial products or inside the human gastrointestinal tract (GIT). Moreover, many bioactive proteins have poor absorption characteristics within the GIT. Colloidal systems, which contain nanoparticles or microparticles, can be designed to encapsulate, retain, protect, and deliver bioactive proteins...
February 16, 2018: Advances in Colloid and Interface Science
Jiri Bartek, Kristin Sjåvik, Samuel Schaible, Sasha Gulati, Ole Solheim, Petter Förander, Asgeir Store Jakola
OBJECTIVE: To investigate the role of angiotensin converting enzyme (ACE) inhibitors in recurrence of chronic subdural hematoma (cSDH) after burr-hole surgery. MATERIALS AND METHODS: A retrospective review was conducted in a Scandinavian multicenter population-based cohort of 1252 adult cSDH patients operated with burr-hole surgery between January 1, 2005 and December 31, 2010. The risk of cSDH recurrence was assessed in users of ACE inhibitors, users of angiotensin II receptor blockers (ARB) and those without ACE inhibitor treatment (no ACE inhibitor group) using univariable and multivariable regression analyses...
February 22, 2018: World Neurosurgery
Robert H G Schwinger
Elderly people show increased probability to develop atherosclerotic diseases; in consequence heart failure - most often following coronary heart disease - as well as atrial fibrillation is more common. Following guidelines may lead to polypharmacy, i. e. use of more than 5 drugs daily. Thus, drug interactions as well as side effects become more likely; especially in elderly patients reduced kidney function has to be taken into account. Only drugs which have shown to prolong life or to reduce symptoms in controlled clinical trials should be used...
February 2018: Deutsche Medizinische Wochenschrift
Claudio Borghi, Maddalena Veronesi
Angiotensin converting enzyme (ACE) inhibitors are extensively used for the prevention and treatment of cardiovascular diseases with a wide range of clinical recommendations. The use of ACE inhibitors can cause the onset of a dry cough, whose prevalence has probably been overestimated because of the lack of adequate control. A correct interpretation of available data requires a careful evaluation of placebo-controlled studies to definitely assess the rate of the most frequent adverse event of ACE inhibition...
February 22, 2018: Clinical Pharmacology and Therapeutics
Linhong Jiang, Ruiming Zhu, Qian Bu, Yan Li, Xue Shao, Hui Gu, Jueying Kong, Li Luo, Hailei Long, Wei Guo, Jingwei Tian, Yinglan Zhao, Xiaobo Cen
Methamphetamine (METH) abuse has become a major public health concern worldwide without approved pharmacotherapies. The brain renin-angiotensin system (RAS) is involved in the regulation of neuronal function as well as neurological disorders. Angiotensin II (Ang II), which interacts with Ang II type 1 receptor (AT1 -R) in the brain, plays an important role as a neuromodulator in dopaminergic transmission. However, the role of brain RAS in METH-induced behavior is largely unknown. Here, we revealed that repeated METH administration significantly upregulated the expression of AT1 -R in the striatum of mice, but downregulated dopamine D3 receptor (D3R) expression...
February 20, 2018: Neurotherapeutics: the Journal of the American Society for Experimental NeuroTherapeutics
Shubha Bhat, Mayank Kansal, George T Kondos, Vicki Groo
BACKGROUND: National guidelines recommend angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) and β-blockers (BBs) at target doses for morbidity and mortality benefits in heart failure with reduced ejection fraction (HFrEF); regardless, titration of these therapies in practice remains suboptimal. We implemented an outpatient pharmacist-managed HFrEF medication titration assistance clinic (MTAC) at one institution to improve titration for general cardiology (GC) patients...
February 1, 2018: Annals of Pharmacotherapy
Kwang Yong Shim, Young Woo Eom, Moon Young Kim, Seong Hee Kang, Soon Koo Baik
The renin-angiotensin system (RAS) is an important regulator of cirrhosis and portal hypertension. As hepatic fibrosis progresses, levels of the RAS components angiotensin (Ang) II, Ang-(1-7), angiotensin-converting enzyme (ACE), and Ang II type 1 receptor (AT1R) are increased. The primary effector Ang II regulates vasoconstriction, sodium homoeostasis, fibrosis, cell proliferation, and inflammation in various diseases, including liver cirrhosis, through the ACE/Ang II/AT1R axis in the classical RAS. The ACE2/Ang-(1-7)/Mas receptor and ACE2/Ang-(1-9)/AT2R axes make up the alternative RAS and promote vasodilation, antigrowth, proapoptotic, and anti-inflammatory effects; thus, countering the effects of the classical RAS axis to reduce hepatic fibrogenesis and portal hypertension...
February 21, 2018: Korean Journal of Internal Medicine
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