Prevalence and Clinical Characteristics of Refractory Hypertension

Armario, Pedro; Calhoun, David A.; Oliveras, Anna; Blanch, Pedro; Vinyoles, Ernest; Banegas, José R.; Gorostidi, Manuel; Segura, Julián; Ruilope, Luís M.; Dudenbostel, Tanja; Sierra, Alejandro de la

doi:10.1161/jaha.117.007365

Cited by 59 publications

(46 citation statements)

References 27 publications

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“…Hypertension is a worldwide disease, while the prevalence of hypertension arising and the control rate is less than 20% in China (Armario et al, 2017; Lu et al, 2017). Vascular function plays a vital role in the maintenance of normal blood pressure.…”

Section: Introductionmentioning

confidence: 99%

Endothelial-Dependent and Independent Vascular Relaxation Effect of Tetrahydropalmatine on Rat Aorta

et al. 2019

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Tetrahydropalmatine (THP) is an active natural alkaloid isolated from Corydalis yanhusuo W.T. Wang which has been widely used for treating pain and cardiovascular disease in traditional Chinese medicine. Previous studies suggested THP have various pharmacological effects in neural and cardio tissue while the vascular reactivity of THP was not fully established. The present study found that THP relaxed rat aorta which contracted by phenylephrine (Phe), KCl, and U46619. The vascular relaxation effect of THP was partially attenuated by PI3K inhibitor wortmannin, Akt inhibitor IV, endothelial nitric oxide synthetase (eNOS) inhibitor L-NAME, guanylate cyclase inhibitors and the mechanical removal of endothelium. Also, the eNOS substrate L-arginine reversed the inhibition effect of L-NAME on THP-induced vascular relaxation. THP also induced intracellular NO production in human umbilical vein endothelial cells. However, Pre-incubation with β-adrenergic receptor blocker propranolol, angiotensin II receptor 1 (AT1) inhibitor losartan, angiotensin II receptor 2 (AT1) inhibitor PD123319 or angiotensin converting enzyme inhibitor enalapril enhanced the vascular relaxation effect of THP. THP did not affect the angiotensin II induced vascular contraction. Cyclooxygenase-2 (COX2) inhibitor indomethacin did not affect the vascular relaxation effect of THP. Furthermore, pre-treatment THP attenuated KCl and Phe induced rat aorta contraction in standard Krebs solution. In Ca 2+ free Krebs solution, THP inhibited the Ca 2+ induced vascular contraction under KCl or Phe stress and reduced KCl stressed Ca 2+ influx in rat vascular smooth muscle cells. THP also inhibited intracellular Ca 2+ release induced vascular contraction by blocking Ryr or IP3 receptors. In addition, the voltage-dependent K + channel (Kv) blocker 4-aminopyridine, ATP-sensitive K + channel (KATP) blocker glibenclamide and inward rectifying K + channel blocker BaCl 2 attenuated THP induced vascular relaxation regardless of the Ca 2+ -activated K + channel (KCa) blocker tetraethylammonium. Thus, we could conclude that THP relaxed rat aorta in an endothelium-dependent and independent manner. The underlying mechanism of THP relaxing rat aorta involved PI3K/Akt/eNOS/NO/cGMP signaling path-way, Ca 2+ channels and K + channels rather than COX2, β-adrenergic receptor and renin-angiotensin system (RAS). These findings indicated that THP might be a potent treatment of diseases with vascular dysfunction like hypertension.

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Section: Introductionmentioning

confidence: 99%

Endothelial-Dependent and Independent Vascular Relaxation Effect of Tetrahydropalmatine on Rat Aorta

et al. 2019

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“…12 Entre os hipertensos resistentes, estima-se que 5 a 8% sejam refratários, embora exista ainda um número muito limitado de estudos que fizeram esta avaliação. [13][14][15]…”

Section: Epidemiologiaunclassified

Hipertensão resistente: abordagem clínica

Muxfeldt

Barreira

Rodrigues

2018

Rev. Fac. Ciênc. Méd. Sorocaba

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Hipertensão arterial resistente é definida como a pressão arterial de consultório não controlada, apesar do uso de três ou mais anti-hipertensivos, incluindo, preferencialmente, um diurético. Indivíduos em uso de quatro ou mais medicamentos com controle pressórico também são considerados hipertensos resistentes. Por sua vez, hipertensão refratária é a pressão arterial não controlada, apesar do uso de cinco ou mais drogas, incluindo um tiazídico de ação prolongada e um antagonista da aldosterona. Sua prevalência vem crescendo com o envelhecimento da população e o avanço da obesidade, estando relacionada às altas taxas de morbidade e mortalidade de origem cardiovascular e renal. A abordagem diagnóstica se baseia em quatro pontos: afastar pseudorresistência, identificar o fenômeno do jaleco branco, investigar causas secundárias e identificar lesões subclínicas para estratificação do risco cardiovascular. O objetivo terapêutico é o controle da pressão arterial de 24 horas. Mudanças de estilo de vida devem ser implementadas e as três primeiras drogas devem incluir um diurético adequado, um inibidor do sistema renina-angiotensina-aldosterona e um bloqueador de canais de cálcio. Persistindo o descontrole pressórico, adicionamos a quarta droga: espironolactona. Quanto aos hipertensos refratários, novas modalidades terapêuticas vêm sendo desenvolvidas, como a denervação renal e a estimulação do barorreflexo.

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“…AH is frequently associated with various metabolic diseases including abdominal obesity (AO) 5,6 . In fact, at least 60% of AO patients were reported having mildto-moderate AH 7 and 15-20% of them had severeto-refractory AH 8 . Moreover, endothelial dysfunc-tion, dyslipidaemia, insulin resistance (IR), increased serum uric acid (SUA) -hypeuricemia (HUE), microvascular inflammation, which are accompanied to both AH and AO, can accelerate atherosclerosis, mediate pro-coagulation state and sufficiently elevate a risk of CV complications [9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of fixed dose of triple combination of perindopril-indapamide-amlodipine in obese patients with moderate-to-severe arterial hypertension: an open-label 6-month study

et al. 2019

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Background: Arterial hypertension (AH) remains the most common cardiovascular (CV) risk factor worldwide. Methods: Seventy five moderate-to-severe hypertensive patients with abdominal obesity aged from 48 to 66 years (45/30 men and women respectively) were selected from the entire cohort (n = 375) according to the inclusion and exclusion criteria. The patients were divided into two subgroups depending on the arm of antihypertensive therapy lines. The first subgroup of patients (n = 36) received a non-fixed combination of oral antihypertensive agents: perindopril (4-8 mg daily), indapamide (1.25-2.5 mg daily) and amlodopine (5-10 mg daily). The second subgroup of patients (n=39) received fixed-dosed combination of these antihypertensive agents aforementioned in the ranged doses (4 mg/1.25mg/5 mg; 4 mg/1.25mg/10 mg; 8 mg/2.5 mg/5 mg; 8 mg/2.5mg/10 mg) in the same manner. The examinations of the clinical status, office, and ambulatory blood pressure values were carried out at baseline in 3 and 6 months after study entry. Results: The frequencies of BP target levels after treatment were higher in the fixed-dose combination group than in the non-fixed combination (at 3 months: 80% versus 58%, p<0.05 and at 6 months: 85% versus 53%, p<0.05). The adherence to triple fixed-dose combination was also higher in comparison with one to non-fixed combination (at 3 months: 82% versus 64%, p<0.05 and at 6 months: 87% versus 61%, p<0.05). It has been established that low-dose of perindopril/indapamide/amlodopine (4mg/1.25/10mg and 8mg/2.5/5mg) were used frequently in fixed-dose combination cohort of patients than in non-fixed combination (15% versus 0%, P<0.05, and 33% versus 19%, p<0.05, respectively). At the same time, maximum doses of these agents (8mg/2.5mg/10mg) were required for achieving target BP levels in a significantly lower proportion of patients receiving fixed-dose combination as compared to patients receiving non-fixed combination (52% versus 81%, p<0.05). Additionally, the triple fixed-dose combination has proved to be better in restoring ambulatory blood pressure monitoring profile than non-fixed combination. Conclusion: Achievement of target blood pressure levels in patients with uncontrolled arterial hypertension and abdominal obesity was possible at lower doses of perindopril, indapamide, and amlodipine when used as a fixed-dose combination rather than non-fixed (free) combination. Key words: abdominal obesity, antihypertensive therapy, arterial hypertension, fixed-dose combination of antihypertensive agents, non-fixed combination of antihypertensive agents Cite this article : Koval S M, Snihurska I O, Starchenko T G, Penkova M Y, Mysnychenko O V, Yushko K O, Lytvynova O M, Vysotska O, Berezin A E. Efficacy of fixed dose of triple combination of perindoprilindapamide-amlodipine in obese patients with moderate-to-severe arterial hypertension: an open-label 6-month study. Biomed. Res. Ther.; 6(11):3501-3512. 3501 History •

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Prevalence and Clinical Characteristics of Refractory Hypertension

Cited by 59 publications

References 27 publications

Endothelial-Dependent and Independent Vascular Relaxation Effect of Tetrahydropalmatine on Rat Aorta

Endothelial-Dependent and Independent Vascular Relaxation Effect of Tetrahydropalmatine on Rat Aorta

Hipertensão resistente: abordagem clínica

Efficacy of fixed dose of triple combination of perindopril-indapamide-amlodipine in obese patients with moderate-to-severe arterial hypertension: an open-label 6-month study

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