scholarly journals Renin-Angiotensin System Blockade Improves Cardiac Indices in Acromegaly Patients

2017 ◽  
Vol 125 (06) ◽  
pp. 365-367 ◽  
Author(s):  
Julia Thomas ◽  
Abhishek Dattani ◽  
Filip Zemrak ◽  
Thomas Burchell ◽  
Scott Akker ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cardiac Effect ◽  
Volume Index ◽  
Converting Enzyme Inhibitors ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Cardiac Indices

AbstractBlockade of the angiotensin-renin system, with angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs), has been shown to improve cardiac outcomes following myocardial infarction and delay progression of heart failure. Acromegaly is associated with a disease-specific cardiomyopathy, the pathogenesis of which is poorly understood.The cardiac indices of patients with active acromegaly with no hypertension (Group A, n=4), established hypertension not taking ACEi/ARBs (Group B, n=4) and established hypertension taking ACEi/ARBs (Group C, n=4) were compared using cardiac magnetic imaging.Patients taking ACEi/ARBs had lower end diastolic volume index (EDVi) and end systolic volume index (ESVi) than the other 2 groups ([C] 73.24 vs. [A] 97.92 vs. [B] 101.03 ml/m2, ANOVA p=0.034, B vs. C p<0.01). Groups A and B had EDVi and ESVi values at the top of published reference range values; Group C had values in the middle of the range.Acromegaly patients on ACEi/ARBs for hypertension demonstrate improved cardiac indices compared to acromegaly patients with hypertension not taking these medications. Further studies are needed to determine if these drugs have a beneficial cardiac effect in acromegaly in the absence of demonstrable hypertension.

scholarly journals Renin-angiotensin system antagonists are associated with lower mortality in hypertensive patients with COVID-19

2020 ◽  
Vol 65 (4) ◽  
pp. 123-126 ◽  
Author(s):  
Michael Megaly ◽  
Mattew Glogoza
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Meta Analysis ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Lower Mortality ◽  
Converting Enzyme Inhibitors ◽  
Hypertensive Patients ◽  
Risk Of Death ◽  
Receptor Blockers

The use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) in patients with Coronavirus 2019 (COVID-19) has been controversial. We performed a meta-analysis of all published studies that reported the outcomes of ACEIs/ARBs in patients with COVID-19. We included four observational studies (3,267 patients). The use of ACEIs/ARBs was associated with a similar risk of all-cause death (OR: 0.75, 95% CI [0.36, 1.57], p = 0.45). Sensitivity analysis including only hypertensive patients demonstrated a lower risk of death with ACEIs/ARBs use (OR: 0.57, 95% CI [0.32-0.98], p = 0.04). In conclusion, hypertensive patients with COVID-19 treated with ACEIs/ARBS have a lower mortality but further research is needed.

Effect of non-anticancer drugs on prognosis of pancreatic cancer (PaC) receiving chemotherapy.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 309-309
Author(s):  
Yousuke Nakai ◽  
Hiroyuki Isayama ◽  
Suguru Mizuno ◽  
Takashi Sasaki ◽  
Kazumichi Kawakubo ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Anticancer Drugs ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Locally Advanced ◽  
Renin Angiotensin System ◽  
Progression Free Survival ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

309 Background: Non-anticancer drugs such as metformin or statin are reported to have a potential role in cancer treatment and we previously reported inhibition of renin-angiotensin system (RAS) by angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) lead to better prognosis in PaC receiving gemcitabine (Br J Cancer 103: 1644-8). The relation between diabetes (DM) with its medication and the incidence of PaC has been described but its impact on prognosis is still unclear. Methods: We retrospectively reviewed 250 pts with advanced PaC receiving chemotherapy with gemcitabine and/or S-1 between June 2001 and April 2011 with a median follow up of 9.9 months (Mo). Univariate and multivariate analyses of progression-free survival (PFS) and overall survival (OS) were performed in pts with and without DM, using age, gender, BMI, PS, stage, protocol, DM with its treatment, hypertension (HT) with its treatment, and use of statin as variables. Results: DM was diagnosed in 124 pts (49%) and was treated with insulin or insulin analogs (n = 59), sulfonylurea (n = 38), biguanide (n = 8), thiazolidinedione (n = 6), and alpha-glucosidase inhibitor (n = 5). Statin was used in 16 pts with DM and 14 pts without DM. Locally advanced disease (44% vs. 29%) and HT (44% vs. 28%) were more prevalent in pts with DM. PFS (6.3 vs. 4.9 Mo, P = 0.440) and OS (13.3 vs. 10.0 Mo, P = 0.084) was longer in pts with DM, though not significantly. Use of statin in pts with DM was associated with longer PFS (11.6 vs. 6.0 Mo, P = 0.034) and longer OS (25.4 vs. 11.3 Mo, P = 0.006), while PFS and OS did not differ by the use of statin in pts without DM. Multivariate subgroup analysis with and without DM showed metastatic disease (Hazard ratio [HR] 2.11, P = 0.001 and HR 1.57, P = 0.013), PS 0-1 (HR 0.08, P <0.001 and HR 0.21, P <0.001), use of ACEI/ARB (HR 0.60, P = 0.030 and HR 0.46, P = 0.031) as common prognostic factors for OS. Doublet chemotherapy (HR 0.48, P = 0.007) and use of statin (HR 0.40, P = 0.010) were prognostic only in pts with DM, but any medications for DM were not significant prognostic factors. Conclusions: In our retrospective analysis, use of statin in pts with DM as well as inhibition of RAS was associated with better prognosis in pts with PaC receiving chemotherapy.

scholarly journals Dual Blockade of the Renin-Angiotensin System: A Strategy that Should Be Reconsidered in Cardiorenal Diseases?

Nephron ◽  
2021 ◽  
pp. 1-8
Author(s):  
Mei Mei ◽  
Zulian Zhou ◽  
Qian Zhang ◽  
Yi Chen ◽  
Hongwen Zhao ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Individualized Therapy ◽  
Converting Enzyme Inhibitors ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
System A ◽  
Receptor Blockers

Studies on pharmacological mechanisms demonstrated that a strategy of dual renin-angiotensin system (RAS) blockade may have a synergistic effect in the treatment of cardiorenal diseases and may reduce adverse reactions. However, some previous clinical studies reported that dual RAS blockade did not significantly benefit many patients with cardiorenal diseases and increased the risk of hyperkalemia, hypotension and renal function damage. Therefore, the current clinical guidelines suggest that the combined use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) should be used with caution in the clinic. However, these studies enrolled older patients with cardiovascular risk factors, and the results of these trials may not be generalized to the overall population. Some clinical evidence suggests that the combination of low-dose ACEIs and ARBs leads to more effective RAS blockade with few adverse effects. The advent of new RAS inhibitors with superior pharmacological effects provides a more suitable drug choice for individualized therapy for dual RAS blockade. Therefore, the choice of appropriate ARBs/ACEIs for individualized therapy based on patient condition may be a better way to improve the efficiency and safety of the dual RAS blockade strategy.

scholarly journals Targeting the Angiotensin II Type 1 Receptor in Cerebrovascular Diseases: Biased Signaling Raises New Hopes

2021 ◽  
Vol 22 (13) ◽  
pp. 6738
Author(s):  
Céline Delaitre ◽  
Michel Boisbrun ◽  
Sandra Lecat ◽  
François Dupuis
Keyword(s):  
Angiotensin Ii ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cerebrovascular Diseases ◽  
Converting Enzyme Inhibitors ◽  
Beneficial Effects ◽  
Biased Signaling

The physiological and pathophysiological relevance of the angiotensin II type 1 (AT1) G protein-coupled receptor no longer needs to be proven in the cardiovascular system. The renin–angiotensin system and the AT1 receptor are the targets of several classes of therapeutics (such as angiotensin converting enzyme inhibitors or angiotensin receptor blockers, ARBs) used as first-line treatments in cardiovascular diseases. The importance of AT1 in the regulation of the cerebrovascular system is also acknowledged. However, despite numerous beneficial effects in preclinical experiments, ARBs do not induce satisfactory curative results in clinical stroke studies. A better understanding of AT1 signaling and the development of biased AT1 agonists, able to selectively activate the β-arrestin transduction pathway rather than the Gq pathway, have led to new therapeutic strategies to target detrimental effects of AT1 activation. In this paper, we review the involvement of AT1 in cerebrovascular diseases as well as recent advances in the understanding of its molecular dynamics and biased or non-biased signaling. We also describe why these alternative signaling pathways induced by β-arrestin biased AT1 agonists could be considered as new therapeutic avenues for cerebrovascular diseases.

scholarly journals Potential effects of COVID-19 on the cardiovascular system

2020 ◽  
Vol 2 (2) ◽  
pp. 133-139
Author(s):  
Tatyana V. Mikhaylovskaya ◽  
Nataliya D. Yakovleva ◽  
Maksim A. Safronov ◽  
Yana I. Kharlamova
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Vascular Inflammation ◽  
Renin Angiotensin System ◽  
Antiplatelet Agents ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cardiovascular Complications ◽  
Cerebrovascular Diseases ◽  
Converting Enzyme Inhibitors ◽  
Coronary Syndrome

It is known that coronaviruses can cause acute coronary syndrome, arrhythmias, and aggravation of heart failure, mainly due to a combination of a significant systemic inflammatory response and a local vascular inflammation at the level of arterial plaque. In the context of massive SARS-CoV-2infections and the announced pandemic, there is a need to update management of cardiovascular patients in order to reduce COVID-19-related complications. COVID-19 can cause viral pneumonia, as well as extrapulmonary symptoms and complications. A larger proportion of severe COVID-19 patients had a cardiovascular disease or a high cardiovascular risk. The presence of arterial hypertension and other cardiovascular and cerebrovascular diseases is considered as a factor aggravating the course of the disease and increasing the lethality. Severe cases of COVID-19 were accompanied by acute, often lethal, cardiovascular disorders, with an increase in the level of highly sensitive troponins. There is no reliable evidence that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can increase the risk of infection or severe course of COVID-19, so there is no reason to cancel them. The role of inhibition of the renin-angiotensin system in the treatment of COVID-19 remains controversial. COVID-19 treatment boils down to supportive care and treatment for complications. Based on the results of the studies, a large number of cardiovascular complications of COVID-19 can be expected. Their therapy should be carried out strictly according to modern guidelines. Recommendations include antiplatelet agents, -blockers, ACE inhibitors and statins.

scholarly journals Renin-Angiotensin System Blockade and Mortality in Patients With Hypertension and COVID-19 Infection

2020 ◽  
Vol 25 (6) ◽  
pp. 503-507 ◽  
Author(s):  
Husam M. Salah ◽  
Guisseppe Calcaterra ◽  
Jawahar L. Mehta
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Angiotensin System ◽  
Receptor Blockers

To determine the effect renin-angiotensin system blockers on the outcome in patients with hypertension and concurrent COVID-19 infection, we searched PubMed, the Cochrane Library, and Google Scholar for relevant articles. Twelve studies with a total of 16,101 patients met the inclusion criteria. The mortality rate among the users of angiotensin converting enzyme inhibitors or angiotensin receptor blockers was 12.15% and in non-users it was 14.56% (risk ratio 0.70, 95% CI [0.53-0.91], P < 0.007). There was no difference in the risk of death between the use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers (risk ratio 1.09, 95% CI [0.90 -1.32]). We conclude that the use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers improves mortality in patients with hypertension and concurrent COVID-19 infection, without a significant difference between ACEIs and ARBs in this population.

scholarly journals Aktivnost' renin-angiotenzinovoy sistemy (RAS) zhirovoy tkani: metabolicheskie effekty blokady RAS

2011 ◽  
Vol 8 (1) ◽  
pp. 21-25 ◽  
Author(s):  
M V Shestakova
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Visceral Obesity ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Fat Tissue ◽  
Converting Enzyme Inhibitors ◽  
Angiotensin System ◽  
Receptor Blockers

The review presents data confirming that fat tissue is a significant source of synthesis of all components of renin-angiotensin system (RAS). It is proposed that activation of fat tissue RAS components have a local paracrine and autocrine actions on adipocytes, regulates their growth and differentiation, induces subclinical inflammation and insulin resistance (IR). Thus, hyperactivity of local RAS in fat tissue is one of the mechanisms of visceral obesity, IR and metabolic syndrome. Use of traditional RAS blocking medications (angiotensin converting enzyme inhibitors, angiotensin receptor blockers) is followed by IR decrease and prevents from development of type 2 diabetes mellitus. The perspectives of use of a new RAS blocker from a group of direct rennin inhibitors - aliskiren - for correction of metabolic abnormalities in visceral obesity are considered.

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