Hypothesis: Unrecognized actions of ENaC blockade in improving refractory-resistant hypertension and residual cardiovascular risk

Elijovich, Fernando; Kirabo, Annet; Laffer, Cheryl L.

doi:10.1016/j.ijchy.2020.100048

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…( 175 ) Even in treated hypertensive patients roughly 30% suffer from left ventricular hypertrophy (29%), diastolic (21%) or systolic (6%) ventricular dysfunction, left atrial expansion (15%), and silent myocardial ischemia (6%). In 13% of this group three or more of these abnormalities occur in combination ( 176 ). Apparently, anti-hypertensive therapy does not alter all components of the underlying mechanisms of hypertension that confer CV risk independent of blood pressure ( 176 ).…”

Section: Residual Risk Factorsmentioning

confidence: 99%

“…In 13% of this group three or more of these abnormalities occur in combination ( 176 ). Apparently, anti-hypertensive therapy does not alter all components of the underlying mechanisms of hypertension that confer CV risk independent of blood pressure ( 176 ). Current guidelines therefore advise lifestyle changes, lipid-lowering therapy, antiplatelet therapy and fasting glucose management depending on the risk profile of the patient ( 177 ).…”

Section: Residual Risk Factorsmentioning

confidence: 99%

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High residual cardiovascular risk after lipid-lowering: prime time for Predictive, Preventive, Personalized, Participatory, and Psycho-cognitive medicine

Reijnders,

van der Laarse,

Jukema

et al. 2023

Front. Cardiovasc. Med.

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As time has come to translate trial results into individualized medical diagnosis and therapy, we analyzed how to minimize residual risk of cardiovascular disease (CVD) by reviewing papers on “residual cardiovascular disease risk”. During this review process we found 989 papers that started off with residual CVD risk after initiating statin therapy, continued with papers on residual CVD risk after initiating therapy to increase high-density lipoprotein-cholesterol (HDL-C), followed by papers on residual CVD risk after initiating therapy to decrease triglyceride (TG) levels. Later on, papers dealing with elevated levels of lipoprotein remnants and lipoprotein(a) [Lp(a)] reported new risk factors of residual CVD risk. And as new risk factors are being discovered and new therapies are being tested, residual CVD risk will be reduced further. As we move from CVD risk reduction to improvement of patient management, a paradigm shift from a reductionistic approach towards a holistic approach is required. To that purpose, a personalized treatment dependent on the individual’s CVD risk factors including lipid profile abnormalities should be configured, along the line of P5 medicine for each individual patient, i.e., with Predictive, Preventive, Personalized, Participatory, and Psycho-cognitive approaches.

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Section: Residual Risk Factorsmentioning

confidence: 99%

Section: Residual Risk Factorsmentioning

confidence: 99%

High residual cardiovascular risk after lipid-lowering: prime time for Predictive, Preventive, Personalized, Participatory, and Psycho-cognitive medicine

Reijnders,

van der Laarse,

Jukema

et al. 2023

Front. Cardiovasc. Med.

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“…The benefit/risk ratio for RDN in resistant hypertension may prima facie be considered analogous to the cancer example above, because of the very high cardiovascular risk of this population despite four-drug treatment [123,124]. However, up to 50% of these subjects are misdiagnosed (poor BP recording technique, white coat effect, high-salt diet, use of pressors), have a treatable secondary cause, or have not been given proven drug therapies such as spironolactone or amiloride [125,126]. Also, nonadherence to therapy must be ruled out (e.g., ambulatory BP monitoring after witnessed intake of medications).…”

Section: Ethical Aspectsmentioning

confidence: 99%

Renal denervation in the antihypertensive arsenal – knowns and known unknowns

Messerli

Bavishi

Brguljan

et al. 2022

Journal of Hypertension

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Even though it has been more than a decade since renal denervation (RDN) was first used to treat hypertension and an intense effort on researching this therapy has been made, it is still not clear how RDN fits into the antihypertensive arsenal. There is no question that RDN lowers blood pressure (BP), it does so to an extent at best corresponding to one antihypertensive drug. The procedure has an excellent safety record. However, it remains clinically impossible to predict whose BP responds to RDN and whose does not. Long-term efficacy data on BP reduction are still unconvincing despite the recent results in the SPYRAL HTN-ON MED trial; experimental studies indicate that reinnervation is occurring after RDN. Although BP is an acceptable surrogate endpoint, there is complete lack of outcome data with RDN. Clear indications for RDN are lacking although patients with resistant hypertension, those with documented increase in activity of the sympathetic system and perhaps those who desire to take fewest medication may be considered.

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“…11 During his time at Vanderbilt, he published extensively, guiding future perspectives of salt sensitivity of blood pressure research. [12][13][14][15][16][17][18][19][20][21][22] Dr Elijovich was actively investigating the role of inflammation in salt-sensitive hypertension in collaboration with our team in the Division of Clinical Pharmacology at Vanderbilt University Medical Center. He was also participating as a mentor for the Zambia-Vanderbilt Training Partnership for HIV-Nutrition-Metabolic Research, collaborating with researchers in Zambia to understand the pathogenesis of salt-sensitive hypertension in people living with HIV in Sub-Saharan Africa and how immune activation and excess dietary Na + intake play a role.…”

mentioning

confidence: 99%