scholarly journals Pharmacological Monotherapy versus Renal Artery Denervation in Controlled Hypertensive Patients

2017 ◽  
Vol 2 ◽  
Author(s):  
Marcio Galindo Kiuchi ◽  
Shaojie Chen ◽  
Gustavo Ramalho e Silva ◽  
Luis Marcelo Rodrigues Paz ◽  
Ary Getulio De Paula Filho ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Renal Sympathetic Denervation ◽  
Converting Enzyme Inhibitors ◽  
Hypertensive Patients ◽  
Renal Artery Denervation ◽  
Change In Mean

<p><strong>Aim: </strong>The aim of this prospective observational non-inferiority study was to compare the capacity for control of essential hypertension between renal sympathetic denervation (RSD) and either angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB).</p><p><strong>Methods and results</strong>: Seventy-four previously controlled essential hypertensive patients on ACEI/ARB monotherapy were evaluated; eleven patients agreed to proceed with RSD and had their antihypertensive agent withdrawn on the day of the procedure. During the six months of follow-up, there was no significant change in mean 24-hour ambulatory blood pressure measurements (ABPM) from baseline to three and sixmonths in the ACEI/ARB group (118±8/80±3 <em>vs.</em> 116±8/79±3 and 115±8/79±4 mmHg, respectively).        No change was also observed in the RSD group (117±8/81±2 <em>vs.</em> 115±6/80±2 and 114±7/79±3 mmHg, respectively). There were no differences between groups at interval time points. There were also no changes in renal function or echocardiographic parameters, during follow-up.</p><p><strong>Conclusions:</strong> For the first time, this study reports possible non-inferiority of RSD when compared to ACEI or ARB monotherapy in the control of essential hypertension. A randomized trial with appropriate concealment of treatment, more patients and an extended follow-up period is needed to evaluate the potential benefits of RSD in comparison to ACEI/ARB use in patients with controlled hypertension.</p>

scholarly journals The Crosstalk between SARS-CoV-2 Infection and the RAA System in Essential Hypertension—Analyses Using Systems Approach

2021 ◽  
Vol 22 (19) ◽  
pp. 10518
Author(s):  
Dorota Formanowicz ◽  
Kaja Gutowska ◽  
Bartłomiej Szawulak ◽  
Piotr Formanowicz
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Arterial Hypertension ◽  
Systems Approach ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Reduce Blood Pressure ◽  
Converting Enzyme Inhibitors ◽  
Hypertensive Patients

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), responsible for the coronavirus disease of 2019 (COVID-19) pandemic, has affected and continues to affect millions of people across the world. Patients with essential arterial hypertension and renal complications are at particular risk of the fatal course of this infection. In our study, we have modeled the selected processes in a patient with essential hypertension and chronic kidney disease (CKD) suffering from COVID-19, emphasizing the function of the renin-angiotensin-aldosterone (RAA) system. The model has been built in the language of Petri nets theory. Using the systems approach, we have analyzed how COVID-19 may affect the studied organism, and we have checked whether the administration of selected anti-hypertensive drugs (angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs)) may impact the severity of the infection. Besides, we have assessed whether these drugs effectively lower blood pressure in the case of SARS-CoV-2 infection affecting essential hypertensive patients. Our research has shown that neither the ACEIs nor the ARBs worsens the course infection. However, when assessing the treatment of hypertension in the active SARS-CoV-2 infection, we have observed that ARBs might not effectively reduce blood pressure; they may even have the slightly opposite effect. On the other hand, we have confirmed the effectiveness of arterial hypertension treatment in patients receiving ACEIs. Moreover, we have found that the simultaneous use of ARBs and ACEIs averages the effects of taking both drugs, thus leading to only a slight decrease in blood pressure. We are a way from suggesting that ARBs in all hypertensive patients with COVID-19 are ineffective, but we have shown that research in this area should still be continued.

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.

scholarly journals Primary Care Prescriptions of Potentially Nephrotoxic Medications in Children with CKD

2019 ◽  
Vol 15 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Claire E. Lefebvre ◽  
Kristian B. Filion ◽  
Pauline Reynier ◽  
Robert W. Platt ◽  
Michael Zappitelli
Keyword(s):  
Primary Care ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Population Based ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Converting Enzyme Inhibitors

Background and objectivesPediatric CKD management focuses on limiting kidney injury, including avoiding nephrotoxic medications. Nephrotoxic medication prescription practices for children with CKD are unknown. Our objective was to determine the prevalence and rates of primary care prescriptions for potentially nephrotoxic medications in children with CKD versus without CKD.Design, setting, participants, & measurementsWe conducted a retrospective, matched population-based cohort study of patients aged <18 years, registered at a general practice participating in the UK Clinical Practice Research Datalink (CPRD) from 1997 to 2017. Children with a clinical code indicating an incident diagnosis of CKD were matched 1:4 to patients without CKD on CKD diagnosis date, sex, age, CPRD practice, and number of general practitioner visits in the year before cohort entry. We calculated the prevalence and the rate of potentially nephrotoxic medication prescriptions throughout the follow-up period in patients with versus without CKD. Primary analyses included the following medication classes: aminoglycosides, antivirals, nonsteroidal anti-inflammatory drugs, salicylates, proton pump inhibitors, and immunomodulators. Secondary analyses used an expanded nephrotoxicity definition that also included, among others, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Adjusted prescription rates were calculated using multivariable binomial regression.ResultsFrom 1,535,816 eligible patients, we identified 1018 incident CKD and 4072 non-CKD matches (mean age, 9.8 years [range, 1.1–17.9 years]; 52% male; mean follow-up time, 3.3 years). Overall, 26% of patients with and 15% of patients without CKD were prescribed one or more potentially nephrotoxic medication during follow-up. The overall rate of nephrotoxic medication prescriptions was 71 (95% confidence interval [95% CI], 55 to 93) prescriptions per 100 person-years in patients with CKD and eight (95% CI, 7 to 9) prescriptions per 100 person-years in patients without CKD (adjusted rate ratio, 4.1; 95% CI, 2.7 to 6.1).ConclusionsPotentially nephrotoxic medications are prescribed at high rates to children with CKD.

Sign in / Sign up

Export Citation Format

Share Document