Plasma Renin Activity–Guided Strategy for the Management of Hypertension

Olson, Nicole; DeJongh, Beth; Hough, Augustus; Parra, David

doi:10.1002/j.1875-9114.2012.01031.x

Cited by 21 publications

(12 citation statements)

References 36 publications

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“…However, the use of renin‐guided therapy in the general hypertensive population for clinical purposes remains controversial. This concept and its limitations were recently reviewed in detail . Briefly, renin‐guided therapy is based on the concept that all chronic essential hypertension is sustained by excess sodium‐volume content (referred to as “V” hypertension), excess renin‐angiotensin‐aldosterone system (RAAS) vasoconstriction (“R” hypertension), or some combination of both.…”

Section: Treatmentmentioning

confidence: 99%

Epidemiology, Prognosis, and Treatment of Resistant Hypertension

Smith

2013

Pharmacotherapy

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Resistant hypertension is a common clinical problem, which, until recently, has received little attention in the medical literature. With this increased attention has come a considerably better understanding of disease epidemiology, prognosis, and treatment, yet much remains unknown. Current data suggest that the prevalence of resistant hypertension has been increasing in recent decades, a concerning finding given that resistant hypertension appears to be associated with a poorer prognosis than nonresistant hypertension. The most appropriate management for these patients has not been fully elucidated, but a multifaceted approach incorporating accurate diagnosis, identification, and removal of substances that interfere with blood pressure, dietary and lifestyle management, and treatment with rational drug combination therapy can be quite effective in controlling blood pressure in these patients. Newer therapies, both pharmacologic and interventional procedures, are under study and may hold promise in the future treatment of resistant hypertension. This review highlights recent research on disease epidemiology and prognosis, and it describes the current body of literature on the treatment of this increasingly common condition.

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Section: Treatmentmentioning

confidence: 99%

Epidemiology, Prognosis, and Treatment of Resistant Hypertension

Smith

2013

Pharmacotherapy

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“…For some individuals, prescribing these medications would provide no significant clinical benefit whereas others may experience potentially fatal side effects. Personalizing (individualizing) the treatment plan provides the opportunity to prescribe medications safer and enables us to better predict the potential efficacy as well as prevent the development of significant side effects [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

CYP2C19 genetic variation and individualized clopidogrel prescription in a cardiology clinic

Mirabbasi

Khalighi

et al. 2017

Journal of Community Hospital Internal Medicine Perspectives

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Background: Clopidogrel (Plavix) is an antiplatelet medication that is routinely used in patients with cardiovascular disease. Cytochrome P2C19 enzymes play a major role in its metabolism, which determines its varied therapeutic level and its effectiveness.Objectives: To customize clopidogrel therapy and evaluate its efficacy by using CYP2C19 genotypic and phenotypic information to improve clinical outcomes in patients.Methods: A total of 465 patients with underlying cardiovascular disease were selected from our out-patient cardiology clinic. DNA sequences of CYP2C19 were analyzed in 465 patients.Results: Of 465 patients, 183 were wild-type homozygous (*1/*1) and 18.8% gain-of function and 19.8% loss-of-function alleles in our patient population The following changes were made: 1) Switching to prasugrel in patients whose genotype noted them to be “Slow metabolizers. This medication adjustment improved clinical outcomes in this patient group.2) Discontinuing or lowering clopidogrel doses in patients whose genotypes noted them to be “Fast or ultra-fast metabolizes” to decrease bleeding risk. For those who were not on clopidogrel but carried abnormal allele(s), “clopidogrel caution” was documented. These individuals were followed up for 3 years and there has not been any cardiac clinical symptoms, cardiac death or excessive bleeding reported.Conclusions: Given the varied effectiveness of clopidogrel due to its metabolism by CYP2C19 enzyme, and the relatively high frequency of both gain-of-function (18.8%) and loss-of-function (19.8%) alleles in our patient population, we believe that genotyping CYP2C19 is clinically important in order to improve patient outcomes and minimize patient risk.

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“…In the absence of genetic data, it is often difficult to predict how a patient will respond to a certain cardiovascular agent, and this is where pharmacogenetics presents potential opportunities for individualizing care. In some cases, nongenetic biomarkers are useful to predict drug response and select therapy, as is the case with plasma renin activity (Olson et al, 2012). However, for other diseases, including thrombotic disease, there is no reliable biomarker to predict drug response prior to drug administration.…”

Section: Cardiovascular Pharmacogenetics and Personalized Medicinementioning

confidence: 99%