scholarly journals Arterial stiffness as a cardiovascular events risk marker and possibilities for its downregulation by contemporary antihypertensive medications

2014 ◽  
Vol 95 (4) ◽  
pp. 575-581 ◽  
Author(s):  
N Sh Zagidullin ◽  
R Kh Zulkarneev ◽  
E S Scherbakova ◽  
Yu F Safina ◽  
Sh Z Zagidullin
Keyword(s):  
Arterial Stiffness ◽  
Cardiovascular Events ◽  
Arterial Wall ◽  
Pulse Wave ◽  
Enzyme Inhibitors ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Wall Stiffness

Arterial blood pressure measured by Korotkov’s method is a non-valid predictor for possible cardiovascular events, which requires introduction of new methods of arterial hypertension diagnostics. Recently, the effect on arterial stiffness has become a very important characteristic of antihypertensive drugs overall efficacy. Evaluation of arterial stiffness (central aortic pressure, augmentation index and pulse wave velocity) contributes to more precise cardiovascular risk stratification and reflects target organ damage and the effectiveness of antihypertensive treatment. In particular, pulse wave velocity exceeding 12 m/s is a significant risk factor of cardiovascular events. Arterial compliance can be determined by applanation tonometry, pulse wave shift at the carotid and femoral arteries, finger photoplethysmography, volume pulsoxymetry, echo-tracking, suprasystolic pulse waves recording method and cardio-ankle vascular index. Different effects of antihypertensive drugs on arterial stiffness at the same blood pressure reduction have been repeatedly shown. The article discusses the impact of the most commonly used antihypertensive drugs, including contemporary antihypertensive drugs combinations, on arterial stiffness. Effect of beta-blockers greatly varies depending on the characteristics of the drug, diuretics have neutral effect, calcium antagonists (especially amlodipine) decrease the pulse wave speed and arterial wall stiffness. Both angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers (more data for enalapril, perindopril and valsartan) were effective in decreasing arterial wall stiffness. A significant reduction in arterial wall stiffness was mainly found if antihypertensive drugs combinations were used, especially the combination of calcium antagonists and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers.

scholarly journals Análise da Revisão Cochrane: Inibidores da Enzima de Conversão da Angiotensina Versus Antagonistas do Receptor da Angiotensina como Prevenção Cardiovascular na Hipertensão Essencial. Cochrane Database Syst Rev. 2014,8: CD009096.

2015 ◽  
Vol 28 (3) ◽  
pp. 283 ◽  
Author(s):  
Luís Nogueira-Silva ◽  
João A. Fonseca
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Cardiovascular Events ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Total Mortality ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are first line drugs in the treatment of hypertension. The aim of this review was to assess if there are differences between these drug classes regarding the prevention of total mortality, occurrence of cardiovascular events and of adverse effects. A systematic review and metanalysis was performed, searching for studies that compare angiotensin converting enzyme inhibitors and angiotensin receptor blockers face-to-face, in several databases until July 2014. The study selection and data extraction were performed by 2 independent researchers. Nine studies were included, with a total of 10 963 participants, 9 398 of which participated in the same study and had high cardiovascular risk. No differences were observed regarding total mortality, cardiovascular mortality or total cardiovascular events. A slightly smaller risk was observed with angiotensin receptor blockers regarding withdrawal due to adverse effects (55 people were needed to be treated with angiotensin receptor blockers for 4.1 years to avoid one withdrawal due to adverse effect), mainly due to the occurrence of dry cough with angiotensin converting enzyme inhibitors. Thus, no differences were observed between angiotensin converting enzyme inhibitors and angiotensin receptor blockers in the prevention of total mortality and cardiovascular events, and angiotensin receptor blockers were better tolerated. Given the large proportion of participants with a high cardiovascular risk, the generalization of these results to other populations is limited.

scholarly journals Management of Hypertension in the Elderly Patient at Abidjan Cardiology Institute (Ivory Coast)

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
K. E. Kramoh ◽  
E. Aké-Traboulsi ◽  
C. Konin ◽  
Y. N'goran ◽  
I. Coulibaly ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Enzyme Inhibitors ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
The Elderly ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

Background. Since the treatment of hypertension is beneficial for the elderly, we have undertaken this study that aims to evaluate the management of hypertension in elderly patient in Côte d'Ivoire.Methods. A retrospective study was conducted among 854 hypertensive elderly patients of Abidjan Cardiology Institute who were followed for a minimum of one year, between January 2000 and December 2009.Results. The patients mean age was years, and 59% were women. At the first presentation, it was mostly systolic-diastolic hypertension (51.8%) and isolated systolic hypertension (38.5%). Mean blood pressure was  mmHg for systolic,  mmHg for diastolic, and  mmHg for pulse pressure. Pulse pressure was ≥60 mmHg in 80.4%. According to the European Guidelines stratification of the cardiovascular risk-excess attributable to high blood pressure, 82.1% of the sample had a very high added risk. The pharmacological therapy was prescribed in 93.5%. More than 66% of patients were receiving ≥2 antihypertensive drugs including fixed-dose combination drugs. The most common agents used were diuretics (63.5%) followed by angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in 61.3%. The most common agents used for monotherapy were calcium antagonists. When ≥2 drugs were used, diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were the most common. Blood pressure control was achieved in 42.6%.Conclusion. The control of elderly hypertension can be effective in Sub-Saharan Africa. He required at least two antihypertensive drugs to meet the recommended blood pressure target.

scholarly journals Arterial Stiffness and Cardiovascular Therapy

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Miodrag Janić ◽  
Mojca Lunder ◽  
Mišo Šabovič
Keyword(s):  
Arterial Stiffness ◽  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Surrogate Marker ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
World Population ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Cardiovascular Morbidity And Mortality

The world population is aging and the number of old people is continuously increasing. Arterial structure and function change with age, progressively leading to arterial stiffening. Arterial stiffness is best characterized by measurement of pulse wave velocity (PWV), which is its surrogate marker. It has been shown that PWV could improve cardiovascular event prediction in models that included standard risk factors. Consequently, it might therefore enable better identification of populations at high-risk of cardiovascular morbidity and mortality. The present review is focused on a survey of different pharmacological therapeutic options for decreasing arterial stiffness. The influence of several groups of drugs is described: antihypertensive drugs (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta-blockers, diuretics, and nitrates), statins, peroral antidiabetics, advanced glycation end-products (AGE) cross-link breakers, anti-inflammatory drugs, endothelin-A receptor antagonists, and vasopeptidase inhibitors. All of these have shown some effect in decreasing arterial stiffness. Nevertheless, further studies are needed which should address the influence of arterial stiffness diminishment on major adverse cardiovascular and cerebrovascular events (MACCE).

scholarly journals Cost minimization analysis of generic and innovator formulations of antihypertensive drugs

2019 ◽  
Vol 8 (12) ◽  
pp. 2625
Author(s):  
Vishalkumar K. Vadgama ◽  
Vishal L. Gaekwad
Keyword(s):  
Cost Analysis ◽  
Enzyme Inhibitors ◽  
Antihypertensive Drugs ◽  
Cost Minimization ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Medication Cost ◽  
National Committee ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors

Background: Hypertension, a chronic condition requiring lifelong care, affects approximately 25.3% Indian population. Average annual hypertension management cost which also includes medication cost varies from Rs. 4042 to 7621, amounting up to 40% of total household income of few families. Selection of a different brand or generic formulation may have an immense impact on total expenditure for treatment of hypertension. Present study aims at determining cost variability and cost analysis of various single drug antihypertensive formulations available in Indian market.Methods: One most prescribed drug, each from Joint National Committee recommended antihypertensive- thiazide diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin-receptor blockers and β blockers were selected for cost analysis. Cheapest, costliest and median priced formulations were searched for individual drugs and were compared to the price of their generic counterparts.Results: Generic formulations of hydrochlorothiazide, amlodipine, enalapril, losartan and atenolol were cheaper even than their respective cheapest innovator formulations. Costliest innovator formulation of amlodipine was 1750% expensive than generic one. Costliest counterparts of generic formulations were many folds overpriced. Similarly, innovator formulation of losartan was up to 953.89% costly than generic one. Innovator formulations of hydrochlorothiazide were the least costly than its generic counterpart, yet being at least 150% more expensive. Also, there exists considerable broad range of price among similar innovator formulations.Conclusions: By prescribing generic antihypertensive drug, we can reduce treatment expenditure by many folds. Same feat can be marginally achieved by using lower cost innovator formulations.

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