scholarly journals Antihypertensive therapy features in multimorbid outpatients

2021 ◽  
Vol 26 (6) ◽  
pp. 688-698
Author(s):  
N. V. Izmozherova ◽  
A. A. Popov ◽  
V. M. Bakhtin ◽  
M. A. Shambatov
Keyword(s):  
Antihypertensive Therapy ◽  
Enzyme Inhibitors ◽  
Antihypertensive Drugs ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cross Sectional Study ◽  
Charlson Index ◽  
Converting Enzyme Inhibitors ◽  
Cross Sectional ◽  
Group 2 ◽  
Group 1

Objective. To assess the characteristics of antihypertensive therapy (AHT) in outpatient patients in relation to comorbidities and multimorbidity level. Design and methods. A cross-sectional study included 140 patients with diagnosed hypertension (HTN). We performed a standardized complaints and medical history registration, questionnaire survey, anthropometry, office blood pressure (BP) assessment. Based on Charlson index the patients were divided into 2 groups: group 1 with moderate multimorbidity (≤ 4 points), group 2 with high multimorbidity level (≥ 5 points). The data are presented as median and proportions with bi-directional 95 % confidence interval. Results. In the sampling of 100 (64,3 71,4 78,6 %) women and 40 (21,4 28,6 35,7 %) men median age was 65 68 70, median Charlson index was 4 5 5. Group with moderate multimorbidity included 63 patients. High multimorbidity group included 77 subjects. HTN degree did not differ between the groups. Subjects from group 2 had higher level of cardiovascular risk (χ2 = 17,2, df = 2, p = 0,00018) and were more likely to have a history of HTN-associated clinical conditions (χ2 = 27,1, df = 2, p = 0,00000). By the time of examination, AHT was started in 137 (95,097,9 100,0%) patients. Monotherapy was ongoing in 20 cases (8,814,3 20,4%), combined AHT was prescribed to 117 (79,6 85,4 91,2 %) persons: 50 (21,2 36,5 43,8 %) patients received 2 drugs, 67 (40,9 48,9 56,9 %) patients received ≥ drugs. Number of antihypertensive drugs was higher in patients of group 2 than in group 1 (χ2 = 6,7, df = 2, p = 0,036). Drug number was not associated with HTN degree (χ2 = 3,8, df = 4, p = 0,44). Patients from group 2 were more likely to take β1-blockers (p = 0,027) and moxonidine (p = 0,042). Non-steroid anti-inflammatory drugs (NSAIDs) reduced the frequency of achieving the target BP level in patients treated by angiotensin converting enzyme inhibitors (p = 0,002). The frequency of achieving target BP was 42,9 50,7 58,6 %, it was independent of the number of prescribed drugs (p = 0,07) and did not differ in the groups of moderate and high multimorbidity (p = 0,87). Conclusions. Multimorbid patients require combined antihypertensive drugs to control hypertension. Multimorbidity level, comorbidities and drug-to-drug interactions should be taken into account during individualized HTN management. NSAID significantly affect the effectiveness of antihypertensive therapy.

scholarly journals Positive association of angiotensin II receptor blockers, not angiotensin-converting enzyme inhibitors, with an increased vulnerability to SARS-CoV-2 infection in patients hospitalized for suspected COVID-19 pneumonia

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244349
Author(s):  
Jean-Louis Georges ◽  
Floriane Gilles ◽  
Hélène Cochet ◽  
Alisson Bertrand ◽  
Marie De Tournemire ◽  
...  
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitors ◽  
Previous Treatment ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers ◽  
Group 2 ◽  
Group 1

Background Angiotensin-converting enzyme 2 is the receptor that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses for entry into lung cells. Because ACE-2 may be modulated by angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), there is concern that patients treated with ACEIs and ARBs are at higher risk of coronavirus disease 2019 (COVID-19) pneumonia. Aim This study sought to analyze the association of COVID-19 pneumonia with previous treatment with ACEIs and ARBs. Materials and methods We retrospectively reviewed 684 consecutive patients hospitalized for suspected COVID-19 pneumonia and tested by polymerase chain reaction assay. Patients were split into two groups, according to whether (group 1, n = 484) or not (group 2, n = 250) COVID-19 was confirmed. Multivariable adjusted comparisons included a propensity score analysis. Results The mean age was 63.6 ± 18.7 years, and 302 patients (44%) were female. Hypertension was present in 42.6% and 38.4% of patients in groups 1 and 2, respectively (P = 0.28). Treatment with ARBs was more frequent in group 1 than group 2 (20.7% vs. 12.0%, respectively; odds ratio [OR] 1.92, 95% confidence interval [CI] 1.23–2.98; P = 0.004). No difference was found for treatment with ACEIs (12.7% vs. 15.7%, respectively; OR 0.81, 95% CI 0.52–1.26; P = 0.35). Propensity score-matched multivariable logistic regression confirmed a significant association between COVID-19 and previous treatment with ARBs (adjusted OR 2.36, 95% CI 1.38–4.04; P = 0.002). Significant interaction between ARBs and ACEIs for the risk of COVID-19 was observed in patients aged > 60 years, women, and hypertensive patients. Conclusions This study suggests that ACEIs and ARBs are not similarly associated with COVID-19. In this retrospective series, patients with COVID-19 pneumonia more frequently had previous treatment with ARBs compared with patients without COVID-19.

scholarly journals Association of Hypertension with All-Cause Mortality among Hospitalized Patients with COVID-19

2020 ◽  
Vol 9 (10) ◽  
pp. 3136 ◽  
Author(s):  
Enrique Rodilla ◽  
Alberto Saura ◽  
Iratxe Jiménez ◽  
Andrea Mendizábal ◽  
Araceli Pineda-Cantero ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Antihypertensive Drugs ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Cross Sectional ◽  
All Cause Mortality ◽  
Study Population ◽  
Receptor Blockers ◽  
Comorbidity Index

It is unclear to which extent the higher mortality associated with hypertension in the coronavirus disease (COVID-19) is due to its increased prevalence among older patients or to specific mechanisms. Cross-sectional, observational, retrospective multicenter study, analyzing 12226 patients who required hospital admission in 150 Spanish centers included in the nationwide SEMI-COVID-19 Network. We compared the clinical characteristics of survivors versus non-survivors. The mean age of the study population was 67.5 ± 16.1 years, 42.6% were women. Overall, 2630 (21.5%) subjects died. The most common comorbidity was hypertension (50.9%) followed by diabetes (19.1%), and atrial fibrillation (11.2%). Multivariate analysis showed that after adjusting for gender (males, OR: 1.5, p = 0.0001), age tertiles (second and third tertiles, OR: 2.0 and 4.7, p = 0.0001), and Charlson Comorbidity Index scores (second and third tertiles, OR: 4.7 and 8.1, p = 0.0001), hypertension was significantly predictive of all-cause mortality when this comorbidity was treated with angiotensin-converting enzyme inhibitors (ACEIs) (OR: 1.6, p = 0.002) or other than renin-angiotensin-aldosterone blockers (OR: 1.3, p = 0.001) or angiotensin II receptor blockers (ARBs) (OR: 1.2, p = 0.035). The preexisting condition of hypertension had an independent prognostic value for all-cause mortality in patients with COVID-19 who required hospitalization. ARBs showed a lower risk of lethality in hypertensive patients than other antihypertensive drugs.

Pharmacokinetic interaction between cefdinir and two angiotensin-converting enzyme inhibitors in rats.

1996 ◽  
Vol 40 (4) ◽  
pp. 979-982 ◽  
Author(s):  
A Jacolot ◽  
M Tod ◽  
O Petitjean
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitors ◽  
Enzyme Inhibitor ◽  
Pharmacokinetic Interaction ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Time Curve ◽  
Converting Enzyme Inhibitors ◽  
Group 2 ◽  
Group 1

The pharmacokinetic interaction between cefdinir and an angiotensin-converting enzyme inhibitor (captopril or quinapril) was investigated in rats. The linearity of cefdinir pharmacokinetics was demonstrated in three groups of rats receiving 10, 20, or 40 mg of cefdinir per kg of body weight intravenously. Then, three other groups of rats were established as follows: group 1 (n = 5) received cefdinir (10 mg/kg) intravenously, and 12 blood samples per rat were drawn between 0 and 8 h after injection of the dose; group 2 (n = 5) was treated in the same way as group 1, but captopril (0.8 mg/kg) was coadministered by intraintestinal injection into all animals; group 3 (n = 6) was treated in the same way as group 2, but quinapril (0.8 mg/kg) replaced captopril. Plasma cefdinir concentrations were measured by liquid chromatography, and the data were analyzed by a noncompartmental method. Finally, three groups of four or five rats each were set up as described above, but the cefdinir dose was 20 mg/kg and the animals were sacrificed 1 h after drug injection to collect blood to determine the unbound cefdinir fraction (fu) by ultrafiltration. The angiotensin-converting enzyme inhibitors increased the mean cefdinir area under the concentration-time curve up to 8 h by a factor of 1.8 (captopril; P < 0.05) and a factor of 3.5 (quinapril; P < 0.05). With captopril, mean cefdinir clearance was decreased by a factor of 2, and the volume of distribution increased by the same factor, while the fu increased from 15.4% +/- 3.0% (cefdinir alone) to 22.8% +/- 10.9% (cefdinir plus captopril). Captopril increased the cefdinir half-life from 0.62 +/- 0.17 to 2.92 +/- 0.95 h. With quinapril, the interaction was so strong that no elimination phase was detectable in four of the six rats, and therefore, no pharmacokinetic parameter values other than the cefdinir fu could be calculated; the cefdinir fu increased to 25.1% +/- 11.1%. It is concluded that captopril and quinapril (and/or their metabolites) have a major impact on the disposition of cefdinir in rats, probably by competition at the plasma protein-binding level and at the tubular anionic carrier level. This latter mechanism should also be relevant in humans.

scholarly journals Angiotensin Receptor 1 Blockers Prolong Time to Recurrence after Radiofrequency Ablation in Hepatocellular Carcinoma patients: A Retrospective Study

Biomedicines ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. 399 ◽  
Author(s):  
Antonio Facciorusso ◽  
Mohamed A. Abd El Aziz ◽  
Ivan Cincione ◽  
Ugo Vittorio Cea ◽  
Alessandro Germini ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Enzyme Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Time To Recurrence ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Inhibition of angiotensin II synthesis seems to decrease hepatocellular carcinoma recurrence after radical therapies; however, data on the adjuvant role of angiotensin II receptor 1 blockers (sartans) are still lacking. Aim of the study was to evaluate whether sartans delay time to recurrence and prolong overall survival in hepatocellular carcinoma patients after radiofrequency ablation. Data on 215 patients were reviewed. The study population was classified into three groups: 113 (52.5%) patients who received neither angiotensin-converting enzyme inhibitors nor sartans (group 1), 59 (27.4%) patients treated with angiotensin-converting enzyme inhibitors (group 2) and 43 (20.1%) patients treated with sartans (group 3). Survival outcomes were analyzed using Kaplan–Meier analysis and compared with log-rank test. In the whole study population, 85.6% of patients were in Child-Pugh A-class and 89.6% in Barcelona Clinic Liver Cancer A stage. Median maximum tumor diameter was 30 mm (10–40 mm) and alpha-fetoprotein was 25 (1.1–2100) IU/mL. No differences in baseline characteristics among the three groups were reported. Median overall survival was 48 months (42–51) in group 1, 51 months (42–88) in group 2, and 63 months (51–84) in group 3 (p = 0.15). Child-Pugh stage and Model for End-staging Liver Disease (MELD) score resulted as significant predictors of overall survival in multivariate analysis. Median time to recurrence was 33 months (24–35) in group 1, 41 (23–72) in group 2 and 51 months (42–88) in group 3 (p = 0.001). Number of nodules and anti-angiotensin treatment were confirmed as significant predictors of time to recurrence in multivariate analysis. Sartans significantly improved time to recurrence after radiofrequency ablation in hepatocellular carcinoma patients but did not improve overall survival.

Abstract 4633: Pretreatment with Mineralcorticoid Receptor Antagonists Plus Beta Blockers and Angiotensin Converting Enzyme Inhibitors Increases the Proportion of Patients in Sinus Rhythm after Electrical Cardioversion for Persistent Atrial Fibrillation and Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Gabriello Marchetti ◽  
Renzo Roncuzzi ◽  
Stefano Urbinati ◽  
Daniela Vivoli ◽  
Alberto Barbieri ◽  
...  
Keyword(s):  
Heart Failure ◽  
Angiotensin Converting Enzyme ◽  
Sinus Rhythm ◽  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Persistent Atrial Fibrillation ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Group 2 ◽  
Group 1

Aim of this study was to assess the effect on sinus rhythm maintenance after electrical cardioversion of pre-treatment with mineralcorticoid receptor antagonist (MRA) added to beta blockers (BB) and angiotensin-converting enzyme inhibitors (ACEI) in patients with heart failure and persistent atrial fibrillation. We studied 168 consecutive patients with left ventricular dysfunction and persistent atrial fibrillation (AF) who underwent electrical cardioversion (ECV) in our Day Hospital.Group 1 (83 pts) was pretreated with MRA plus BB and ACEI and group 2 (85 pts) with only BB and ACEI. Mean age was 74.4 years in group 1 and 73.9 years in group 2; male gender was 70% in group 1 and 72% in group 2 ; estimated onset of arrhythmia was 5 + −2 months in two groups; ischemic heart disease was present in 55% of group 1 and 61% in group 2 .Hypertension was present in 70% of group 1 and 61% in group 2. Echocardio-graphic parameters of left atrial diameter were not statistically different in two groups:44 mm versus 47 mm ; ejection fraction was 46% (group 1) and 44% (group 2).All patients received warfarin during the 1 year follow up. Aldosterone antagonists ( plus BB and ACEI ) was continued in group 1 after ECV. Group 2 received treatment with BB and ACEI. 4 pts in group 1 and 6 pts in group 2 showed early re-initiation of AF after cardioversion and a second ECV was successfully repeated. At 1 year follow up 67% of pts of group 1 remained in sinus rhythm compared with 42% of pts not treated with aldosterone antagonists. The results in our investigation regarding the proportion of pts in sinus rhythm after ECV favour this treatment strategy for patients with persistent AF and heart failure. A possible mechanism of this result is that aldosterone too stimulates collagen production leading to atrial fibrosis. Remodeling process in heart failure can be better antagonized by combined treatment of Beta blockers, Angiotensin Converting-Enzyme inhibitors and Mineralcorticoid receptors Antagonists.

Self-Reported Depressive Symptoms in Association with Medication Exposures among Medical Inpatients: A Cross-Sectional Study

1995 ◽  
Vol 40 (5) ◽  
pp. 264-269 ◽  
Author(s):  
B. Patten Scott ◽  
V.A. Williams Jeanne ◽  
J. Love Edgar
Keyword(s):  
Depressive Symptoms ◽  
Enzyme Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cross Sectional Study ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Cross Sectional ◽  
Medical Inpatients ◽  
History Of ◽  
History Of Depression

Objective To evaluate associations between exposure to three classes of medications (angiotensin converting enzyme inhibitors, calcium channel blockers, and corticosteroids) and self-reported depressive symptoms. Method The study utilised a cross-sectional study design in a sample of medical inpatients. Results Associations between self-reported depressive symptoms and exposure to angiotensin converting enzyme inhibitors or calcium channel blockers were not observed. However, an association between self-reported depressive symptoms and corticosteroid exposure was identified. The association was strongest in subjects reporting apast history of depression or a family history of depression. The strength of the corticosteroid-depressive symptom association was comparable with that of associations observed for age, poverty and psychosocial stress. Conclusions Depressive symptoms among medical inpatients have a biopsychosocial etiology. Corticosteroid exposure may be a biological risk factor for depressive symptoms in this population.

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