scholarly journals Evaluation of Mineralocorticoid Receptor Antagonism on Changes in NT-proBNP Among Persons With HIV

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Suman Srinivasa ◽  
Christopher deFilippi ◽  
Kathleen V Fitch ◽  
Sanjna Iyengar ◽  
Grace Shen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Disease ◽  
Mineralocorticoid Receptor ◽  
Myocardial Dysfunction ◽  
Controlled Trial ◽  
High Sensitivity ◽  
Clinical Trial Registration ◽  
Mineralocorticoid Receptor Antagonism ◽  
System Physiology ◽  
Double Blinded

Abstract Subclinical myocardial dysfunction is prevalent among well-treated persons with HIV (PWH). We have previously demonstrated unique renin-angiotensin-aldosterone system physiology among PWH with metabolic dysregulation. Mineralocorticoid receptor blockade may be a targeted treatment strategy for subclinical heart disease in PWH. Forty-six PWH were randomized to receive either eplerenone 50 mg daily or placebo in a 6-month randomized, double-blinded, placebo-controlled trial. We assessed changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP), a biomarker of cardiac stretch, under controlled posture and dietary conditions. The eplerenone- and placebo-treated groups demonstrated a long duration of HIV with good immunological control. NT-proBNP levels were similar between the groups at baseline (41.1 [20.2, 97.9] vs 48.9 [29.2, 65.4] ng/L, P = .80) and decreased significantly more in the eplerenone- vs placebo-treated groups after 6 months (change NT-proBNP -9.6 [-46.8, 0.3] vs -3.0 [-17.0, 39.9] ng/L, P = .02 for comparison of change between groups). Decreases in NT-proBNP were independent of changes in systolic and diastolic blood pressure, and related to decreases in high-sensitivity C-reactive protein (ρ = 0.32, P = .05) and inversely to increases in serum aldosterone (ρ = -0.33, P = .04) among all participants. Treatment with eplerenone for 6 months vs placebo significantly decreases NT-proBNP levels among PWH, independent of eplerenone’s known blood pressure-lowering effects. Further studies should elucidate whether lowering NT-proBNP in this at-risk metabolic population with subclinical heart disease will offer cardioprotection. Clinical Trial Registration NCT01405456

scholarly journals Microbial Interventions to Control And Reduce Blood Pressure In Australia (Microbia): Rationale And Design of A Double-Blinded Randomised Cross-Over Placebo Controlled Trial

2021 ◽  
Author(s):  
Dakota Rhys-Jones ◽  
Rachel Climie ◽  
Hamdi Jama ◽  
Paul Gill ◽  
Geoffrey Head ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Gut Microbiota ◽  
Resistant Starch ◽  
Corn Starch ◽  
Controlled Trial ◽  
Short Chain Fatty Acids ◽  
Reduce Blood Pressure ◽  
Clinical Trial Registry ◽  
Double Blinded

Abstract Background: Hypertension is a prevalent chronic disease worldwide that remains poorly controlled. Recent studies support the concept that the gut microbiota is involved in the development of hypertension, and that dietary fibre intake may act through the gut microbiota to lower blood pressure (BP). Resistant starch is a type of prebiotic fibre which is metabolized by commensal bacteria in the colon to produce short-chain fatty acids (SCFA), including acetate, propionate, and butyrate. Previous work in pre-clinical models provide strong evidence that both prebiotic fibre as well as SCFAs (i.e. postbiotics) can prevent the development of hypertension. The aim of this clinical trial is to determine if acetylated and butyrylated modified resistant starch can decrease BP of hypertensive individuals via the modulation of the gut microbiota and release of high levels of SCFAs. Methods: This is a phase IIa double-blinded, randomised, cross-over, placebo controlled trial. Participants are randomly allocated to receive either a diet containing 40g/day of the modified resistant starch or placebo (corn starch or regular flour) for three weeks on each diet, with a three week washout period between the two diets. BP is measured in the office, at home, and using a 24 hour ambulatory device. Arterial stiffness is measured using carotid-to-femoral pulse wave velocity. Our primary endpoint is a reduction in ambulatory daytime systolic BP. Secondary endpoints include changes to circulating cytokines, immune markers, and modulation to the gut microbiome. Discussion: The findings of this study will provide the first evidence for the use of a combination of pre- and postbiotics to lower BP in humans. The results are expected at the end of 2021.Trial registration: Australia and New Zealand Clinical Trial Registry ACTRN12619000916145, registered on 1/07/2019.

scholarly journals Effects of Baduanjin on Essential Hypertension: A Study Protocol for a Randomized Controlled Trial

2021 ◽  
Author(s):  
Yuanyuan Guan ◽  
Yang Hao ◽  
Yun Guan ◽  
Dongjun Wang ◽  
Xuan Sun ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Salt Intake ◽  
Controlled Trial ◽  
Trial Registration ◽  
Care Group ◽  
Clinical Trial Registration ◽  
Randomized Controlled ◽  
Incidence And Mortality ◽  
The Impact

Abstract Background: Clinical treatment of hypertension recommends the use of drugs to reduce the incidence and mortality of cardiovascular diseases in hypertensive patients. However, the side effects of long-term medication and economic pressure have increased the medical community's interest in Baduanjin as a method of exercise therapy. Clinical studies have shown that Baduanjin can be used to treat various diseases, and it can also regulate physical and mental factors such as tension and anxiety. This study aims to evaluate the antihypertensive effect of Baduanjin on patients with essential hypertension. Methods/design: In this study, 92 patients with essential hypertension were randomly divided into the Baduanjin group and the routine care group, using a randomized, active control, evaluator blind method, and two parallel control methods, with 46 cases in each group, signed informed Subjects with the consent form will manage their blood pressure by limiting salt intake, losing weight, drinking moderately, exercising, and adjusting dietary intake during the first visit. In addition to self-management, the Baduanjin group will also conduct 30-minute Baduanjin training three times a week for a total of 8 weeks. The main result is the measurement of blood pressure. In addition, body composition will be measured as a secondary result.Discussion: This study is a randomized controlled Baduanjin trial and is not currently widely used. It may provide valuable data on the impact of Baduanjin on essential hypertension, which will inform non-drug treatment options for this disease.Trial registration: Chinese Clinical Trial Registration Center, ChiCTR200003570. Register on August 16, 2020.

Heat stable carbetocin vs. oxytocin for the prevention of post-partum hemorrhage in emergency caesarean delivery: a randomized controlled trial

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shaymaa Al Zubaidi ◽  
Taghreed Alhaidari
Keyword(s):  
Blood Pressure ◽  
Blood Transfusion ◽  
Pulse Rate ◽  
Post Partum ◽  
Controlled Trial ◽  
Relative Risks ◽  
Heat Stable ◽  
Emergency Cesarean ◽  
Clinically Significant ◽  
Double Blinded

Abstract Objectives To evaluate the uterotonic effect of carbetocin compared with oxytocin in emergency cesarean delivery in Iraq. Methods A double-blinded randomized noninferiority single center trial. Three-hundred patients were systematically randomized to intravenous bolus injection of 10 IU oxytocin or 100 mcg carbetocin after delivery in a ratio of 2:1. The primary outcome was additional uterotonic use when inadequate uterine tone occur in the first 24 h after delivery. Secondary outcomes include the need for blood transfusion, blood pressure and pulse rate changes within an hour of drugs administration. Noninferiority margins for the relative risks outcomes was 4%. Results Addition uterotonics use was significantly lower in carbetocin group with a risk ratio of 0.36. Carbetocin was superior to oxytocin in reducing the need for additional uterotonic drugs by 12% and non-inferior to oxytocin for blood transfusion 3.5%. Noninferiority was not shown for the outcome of sever blood loss. Miner changes in blood pressure and pulse rate were observed in carbetocin group compared to oxytocin but clinically were not significant. Conclusions Heat stable carbetocin is effective in reducing additional uterotonics use compared to oxytocin without clinically significant change in blood pressure or pulse rate, therefore, can be a potential alternative in Iraq.

scholarly journals Effects of grape seed extract beverage on blood pressure and metabolic indices in individuals with pre-hypertension: a randomised, double-blinded, two-arm, parallel, placebo-controlled trial

2015 ◽  
Vol 115 (2) ◽  
pp. 226-238 ◽  
Author(s):  
Eunyoung Park ◽  
Indika Edirisinghe ◽  
Ying Yng Choy ◽  
Andrew Waterhouse ◽  
Britt Burton-Freeman
Keyword(s):  
Blood Pressure ◽  
Plasma Lipids ◽  
Controlled Trial ◽  
Grape Seed Extract ◽  
Grape Seed ◽  
Seed Extract ◽  
Functional Ingredient ◽  
Vascular Adhesion ◽  
Double Blinded ◽  
Metabolic Indices

AbstractThe aim of the present study was to test grape seed extract (GSE) as a functional ingredient to lower blood pressure (BP) in individuals with pre-hypertension. A single-centre, randomised, two-arm, double-blinded, placebo-controlled, 12-week, parallel study was conducted in middle-aged adults with pre-hypertension. A total of thirty-six subjects were randomised (1:1) to Placebo (n 18) or GSE (n 18) groups; twenty-nine of them completed all the protocol-specified procedures (Placebo, n 17; GSE, n 12). Subjects consumed a juice (167 kJ (40 kcal)) containing 0 mg (Placebo) or 300 mg/d GSE (150 mg) twice daily for 6 weeks preceded by a 2-week Placebo run-in and followed by 4-week no-beverage follow-up. Compliance was monitored. BP was measured at screening, 0, 6 and 10 weeks of intervention and blood samples were collected at 0, 3, 6 and 10 weeks of intervention. GSE significantly reduced systolic BP (SBP) by 5·6 % (P=0·012) and diastolic BP (DBP) by 4·7 % (P=0·049) after 6 weeks of intervention period, which was significantly different (SBP; P=0·03) or tended to be different (DBP; P=0·08) from Placebo. BP returned to baseline after the 4-week discontinuation period of GSE beverage. Subjects with higher initial BP experienced greater BP reduction; nearly double the effect size. Fasting insulin and insulin sensitivity tended to improve after 6 weeks of GSE beverage supplementation (P=0·09 and 0·07, respectively); no significant changes were observed with fasting plasma lipids, glucose, oxidised LDL, flow-mediated dilation or vascular adhesion molecules. Total plasma phenolic acid concentrations were 1·6 times higher after 6 weeks of GSE v. Placebo. GSE was found to be safe and to improve BP in people with pre-hypertension, supporting the use of GSE as a functional ingredient in a low-energy beverage for BP control.

scholarly journals Sex May Modulate the Effects of Combined Polyphenol Extract and L-citrulline Supplementation on Ambulatory Blood Pressure in Adults with Prehypertension: A Randomized Controlled Trial

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 399
Author(s):  
Cécile Vors ◽  
Maryka Rancourt-Bouchard ◽  
Charles Couillard ◽  
Iris Gigleux ◽  
Patrick Couture ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Lipids ◽  
Vascular Dysfunction ◽  
Controlled Trial ◽  
High Sensitivity ◽  
Potential Interaction ◽  
Double Blind ◽  
Reactive Protein ◽  
The Difference ◽  
Hs Crp

Increased blood pressure (BP), vascular dysfunction and inflammation are involved in the etiology of cardiovascular disease (CVD). Although several dietary components such as polyphenols and L-citrulline may help to control BP, their combined impact on ambulatory BP in individuals at risk of CVD remains unknown. The objective of this research was to investigate the short-term impact of supplementation with a combination of polyphenol extract and L-citrulline on ambulatory BP, endothelial function and inflammation. In a randomized double-blind parallel trial, 73 men and women with prehypertension were supplemented with a placebo (cellulose, n = 34, Plac) or 548 mg/day of polyphenols and 2 g/day of L-citrulline (n = 35, Suppl) for 6 weeks. The primary outcome of this study was the difference between groups in 24-h ambulatory diastolic BP (DBP) at week six. Secondary outcomes were a difference between groups at week six in ambulatory systolic BP (SBP), casual BP, serum lipids and high-sensitivity C-reactive protein (hs-CRP) concentrations and skin advanced glycation end products (AGEs). Potential interaction of treatment with sex was examined. Suppl had no impact on mean ambulatory SBP and DBP (p > 0.10 vs. placebo). Daytime and 24-h SBP were reduced with Suppl in women (p ≤ 0.01), but not in men (p ≥ 0.27). A non-significant reduction in AGEs was observed after Suppl compared to Plac among all participants (p = 0.07) and there was no difference in the concentrations of blood lipids (p > 0.20) or CRP (p = 0.36) between treatments at week six. Therefore, supplementation with polyphenol extract and L-citrulline for 6 weeks has no impact on ambulatory BP, blood lipids and CRP in adults with prehypertension. However, the polyphenol extract/L-citrulline supplement may reduce ambulatory SBP in women, but not in men. These preliminary results need further research efforts towards further documenting this sex-dependent BP response to supplementation with polyphenols and L-citrulline.

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