The Use of Antihypertensive Drugs as Coadjuvant Therapy in Cancer

Cancer is a complex group of diseases that constitute the second largest cause of mortality worldwide. The development of new drugs for treating this disease is a long and costly process, from the discovery of the molecule through testing in phase III clinical trials, a process during which most candidate molecules fail. The use of drugs currently employed for the management of other diseases (drug repurposing) represents an alternative for developing new medical treatments. Repurposing existing drugs is, in principle, cheaper and faster than developing new drugs. Antihypertensive drugs, primarily belonging to the pharmacological categories of angiotensin-converting enzyme inhibitors, angiotensin II receptors, direct aldosterone antagonists, β-blockers and calcium channel blockers, are commonly prescribed and have well-known safety profiles. Additionally, some of these drugs have exhibited pharmacological properties useful for the treatment of cancer, rendering them candidates for drug repurposing. In this review, we examine the preclinical and clinical evidence for utilizing antihypertensive agents in the treatment of cancer.

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Tianma Gouteng Yin as Adjunctive Treatment for Essential Hypertension: A Systematic Review of Randomized Controlled Trials

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2013/706125 ◽

2013 ◽

Vol 2013 ◽

pp. 1-18 ◽

Cited By ~ 14

Author(s):

Jie Wang ◽

Bo Feng ◽

Xiaochen Yang ◽

Wei Liu ◽

Yongmei Liu ◽

...

Keyword(s):

Essential Hypertension ◽

Randomized Clinical Trials ◽

Enzyme Inhibitors ◽

Antihypertensive Drugs ◽

Data Extraction ◽

Angiotensin Converting Enzyme Inhibitors ◽

Deficiency Syndrome ◽

Adjunctive Treatment ◽

Channel Blockers ◽

Converting Enzyme Inhibitors

Background. Tianma Gouteng Yin (TGY) is widely used for essential hypertension (EH) as adjunctive treatment. Many randomized clinical trials (RCTs) of TGY for EH have been published. However, it has not been evaluated to justify their clinical use and recommendation based on TCM zheng classification.Objectives. To assess the current clinical evidence of TGY as adjunctive treatment for EH with liver yang hyperactivity syndrome (LYHS) and liver-kidney yin deficiency syndrome (LKYDS).Search Strategy. 7 electronic databases were searched until November 20, 2012.Inclusion Criteria. RCTs testing TGY combined with antihypertensive drugs versus antihypertensive drugs were included.Data Extraction and Analyses. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards.Results. 22 RCTs were included. Methodological quality was generally low. Except diuretics treatment group, blood pressure was improved in the other 5 subgroups; zheng was improved in angiotensin converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), and “CCB + ACEI” treatment groups. The safety of TGY is still uncertain.Conclusions. No confirmed conclusion about the effectiveness and safety of TGY as adjunctive treatment for EH with LYHS and LKYDS could be made. More rigorous trials are needed to confirm the results.

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Primary stroke prevention and hypertension treatment: which is the first-line strategy?

Neurology International ◽

10.4081/ni.2011.e12 ◽

2011 ◽

Vol 3 (2) ◽

pp. 12 ◽

Cited By ~ 16

Author(s):

Roberta Ravenni ◽

Joe Jabre ◽

Edoardo Casiglia ◽

Alberto Mazza

Keyword(s):

Stroke Prevention ◽

Enzyme Inhibitors ◽

Antihypertensive Agents ◽

Clinical Intervention ◽

Vascular Risk Factor ◽

Angiotensin Converting Enzyme Inhibitors ◽

Fixed Dose ◽

Channel Blockers ◽

Angiotensin Ii Receptor ◽

Converting Enzyme Inhibitors

Hypertension (HT) iis considered the main classic vascular risk factor for stroke and the importance of lowering blood pressure (BP) is well established. However, not all the benefit of antihypertensive treatment is due to BP reduction <em>per se</em>, as the effect of reducing the risk of stroke differs among classes of antihypertensive agents. Extensive evidences support that angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), dihydropyridine calcium channel blockers (CCB) and thiazide diuretics each reduced risk of stroke compared with placebo or no treatment. Therefore, when combination therapy is required, a combination of these antihypertensive classes represents a logical approach. Despite the efficacy of antihypertensive therapy a large proportion of the population, still has undiagnosed or inadequately treated HT, and remain at high risk of stroke. In primary stroke prevention current guidelines recommend a systolic/diastolic BP goal of <140/<90 mmHg in the general population and <130/80 mmHg in diabetics and in subjects with high cardiovascular risk and renal disease. The recent release in the market of the fixed-dose combination (FDC) of ACEI or ARB and CCB should provide a better control of BP. However to confirm the efficacy of the FDC in primary stroke prevention, clinical intervention trials are needed.

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Antihypertensive Drugs and Risk of Cancer: Between Scylla and Charybdis

American Journal of Hypertension ◽

10.1093/ajh/hpaa098 ◽

2020 ◽

Author(s):

Elias Sanidas ◽

Maria Velliou ◽

Dimitrios Papadopoulos ◽

Anastasia Fotsali ◽

Dimitrios Iliopoulos ◽

...

Keyword(s):

Enzyme Inhibitors ◽

Antihypertensive Drugs ◽

Beta Blockers ◽

Angiotensin Converting Enzyme Inhibitors ◽

Current Data ◽

Channel Blockers ◽

Angiotensin Ii Receptor ◽

Converting Enzyme Inhibitors ◽

Carcinogenic Potential ◽

Risk Of Cancer

Abstract Antihypertensive drugs namely angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, beta blockers, and diuretics are among the most clearly documented regimens worldwide with an overall cardioprotective benefit. Given that malignancy is the second leading cause of mortality, numerous observational studies aimed to investigate the carcinogenic potential of these agents with conflicting results. The purpose of this review was to summarize current data in an effort to explore rare side effects and new mechanisms linking antihypertensive drugs with the risk of developing cancer.

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Cardiovascular medication exposures and poisonings in Izmir, Turkey: A 14-year experience

Human & Experimental Toxicology ◽

10.1177/0960327110371256 ◽

2010 ◽

Vol 30 (5) ◽

pp. 347-353

Author(s):

Sule Kalkan ◽

Nil Hocaoglu ◽

Kubilay Oransay ◽

Pinar Unverir ◽

Yesim Tuncok

Keyword(s):

Enzyme Inhibitors ◽

Antihypertensive Drugs ◽

Beta Blockers ◽

Clinical Manifestations ◽

Angiotensin Converting Enzyme Inhibitors ◽

University Hospital ◽

Channel Blockers ◽

Clinical Effects ◽

Age Group ◽

Converting Enzyme Inhibitors

Cardiovascular medications (CVMs) are frequently prescribed for cardiovascular diseases. The unconscious use of cardiovascular drugs may lead to severe clinical manifestations, even to death, especially when in overdose. The objective of this study is to clarify the profile of CVM exposures admitted to Department of Emergency Medicine in Dokuz Eylul University Hospital (EMDEU) between 1993 and 2006. Case demographics, type of the medication, route and reason for exposure, clinical effects and outcome were recorded. Related to the CVM exposures, 105 poisoning cases were admitted. Mean age of children and adults were 12.8 ± 1.0 and 30.1 ± 1.8, respectively. Females were dominating (77.1%). Poisoning by accident occurred mainly among children in the 0—6 age group (64.3%) and suicide attempt was predominant in the 19—29 age group (47.8%). The most common ingested CVMs admitted to EMDEU were calcium channel blockers (19.7%), beta-blockers (17.3%), angiotensin converting enzyme inhibitors and diuretics (11.8%). Most of the patients were asymptomatic (59.1%). Frequently observed symptom was altered consciousness (18.6%). Antihypertensive drugs are responsible for the most of the CVM exposures. Prospectively designed multi-centered studies are needed to reflect the epidemiological properties of cardiovascular drug exposures throughout our country and would be very valuable for the determination of preventive measures.

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Cost minimization analysis of generic and innovator formulations of antihypertensive drugs

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20195268 ◽

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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2289

Journal of Clinical and Translational Science ◽

10.1017/cts.2017.66 ◽

2017 ◽

Vol 1 (S1) ◽

pp. 14-14

Author(s):

David D. Maron ◽

Marc Blackman ◽

Richard Amdur ◽

Thomas Mellman ◽

Kathryn Sandberg

Keyword(s):

Major Depression ◽

Protective Effect ◽

Large Scale ◽

Enzyme Inhibitors ◽

Antihypertensive Drugs ◽

Angiotensin Converting Enzyme Inhibitors ◽

Channel Blockers ◽

Converting Enzyme Inhibitors ◽

Study Population ◽

Age Range

OBJECTIVES/SPECIFIC AIMS: Angiotensin type 1 receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) are frequently prescribed for hypertension and associated cardiovascular and renal complications. In animal models, these drugs also reduce anxiety and depression. OBJECTIVE—to determine if Veteran Affairs (VA) clinical pharmacy data indicate a protective effect of ARBs and/or ACEIs for major depression. METHODS/STUDY POPULATION: Pharmacy records from nationwide VA electronic medical records (EMR) were extracted for patients prescribed ARBs, ACEIs, α-blockers, β-blockers, calcium channel blockers, or diuretics (n=4,081,359). Patients were excluded if: they had not received medications for 6 months with >70% coverage; were diagnosed with substance/alcohol abuse, dementia, psychosis, schizophrenia, or prescribed insulin. The study population was categorized as “ARB/ACEI” (A/A) or “Never ARB/ACEI” (NA/A). Using the Greedy Matching Algorithm, subjects were matched on a 1:1 ratio for sex and race over a 5 year age range resulting in 2 equal groups of n=1,350,236 each. Subjects were older (M=71.6, SD=12) and mostly men (97%). RESULTS/ANTICIPATED RESULTS: In the A/A Versus NA/A, respectively, the incidence of anti-depressant use was greater during (9.9% vs. 8.9%) but was lower after (11.8% vs. 12.2%) the study period. PHQ-2 scores (Mean±SD) were statistically lower, albeit similar, during (0.79±1.56 vs. 0.85±1.63) and after (1.00±1.73 vs. 1.07±1.79) the study period. DISCUSSION/SIGNIFICANCE OF IMPACT: These preliminary data suggest that inhibiting angiotensin II action does not provide a protective effect on major depression when compared with other classes of antihypertensive drugs. This study illustrates how “Big Data” may inform the design, or obviate the need, for large-scale randomized-controlled trials.

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Antihypertensive drug exposure in premature infants from 1997 to 2013

Cardiology in the Young ◽

10.1017/s1047951116001591 ◽

2016 ◽

Vol 27 (5) ◽

pp. 905-911 ◽

Cited By ~ 3

Author(s):

Srikanth Ravisankar ◽

Devon Kuehn ◽

Reese H. Clark ◽

Rachel G. Greenberg ◽

P. Brian Smith ◽

...

Keyword(s):

Birth Weight ◽

Antihypertensive Drug ◽

Premature Infants ◽

Drug Exposure ◽

Enzyme Inhibitors ◽

Antihypertensive Drugs ◽

Angiotensin Converting Enzyme Inhibitors ◽

Systemic Hypertension ◽

Channel Blockers ◽

Converting Enzyme Inhibitors

AbstractBackgroundSystemic hypertension is increasingly recognised in premature infants. There is limited evidence regarding treatment, and most published treatment recommendations are based solely on expert opinions.MethodsWe identified all infants born ⩽32 weeks of gestation and ⩽1500 g birth weight discharged from one of 348 neonatal ICUs managed by the Pediatrix Medical Group between 1997 and 2013. We defined antihypertensive drugs as vasodilators, angiotensin-converting enzyme inhibitors, β receptor blockers, calcium channel blockers, and central α2 receptor agonists. We compared characteristics between infants who were treated with at least one antihypertensive drug during their initial hospitalisation and infants who were not prescribed antihypertensive drugs using Wilcoxon’s ranked sum test or Pearson’s χ2-test.ResultsWe identified 2504/119,360 (2.1%) infants who required at least one antihypertensive drug. The median postnatal age of first exposure was 48 days (25th, 75th percentile 15, 86), and the median length of therapy was 6 days (1, 16). Hydralazine was the most commonly prescribed antihypertensive with 1280/2504 (51.1%) treated infants exposed to the drug. More than two antihypertensive drugs were administered in 582/2504 (23.2%) infants, and 199/2097 (9.5%) of the treated infants were discharged home on antihypertensive therapy. Infants who received antihypertensive drugs were of lower gestational age (p<0.001) and birth weight (p<0.001) compared with infants not prescribed antihypertensive drugs.ConclusionsOur study is the largest to describe current antihypertensive drug exposure in a cohort of exclusively premature infants born ⩽32 weeks of gestation. We found wide variations in practice for treating hypertension in premature infants.

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Comparative Efficacy and Safety of BP-Lowering Pharmacotherapy in Patients Undergoing Maintenance Dialysis

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.12201019 ◽

2020 ◽

Vol 15 (8) ◽

pp. 1129-1138 ◽

Cited By ~ 1

Author(s):

Ahmed M. Shaman ◽

Brendan Smyth ◽

Clare Arnott ◽

Suetonia C. Palmer ◽

Anastasia S. Mihailidou ◽

...

Keyword(s):

Confidence Interval ◽

Angiotensin Converting Enzyme ◽

Enzyme Inhibitors ◽

Angiotensin Receptor Blockers ◽

Angiotensin Converting Enzyme Inhibitors ◽

Channel Blockers ◽

Converting Enzyme ◽

Converting Enzyme Inhibitors ◽

Aldosterone Antagonists ◽

Maintenance Dialysis

Background and objectivesElevated BP is an important risk factor for cardiovascular disease, with a prevalence of over 80% in patients undergoing maintenance dialysis. We assessed the comparative BP-lowering efficacy and the safety of BP-lowering drugs in patients undergoing maintenance dialysis.Design, settings, participants, & measurements We performed a frequentist random effects network meta-analysis of randomized, controlled trials evaluating BP-lowering agents in adult patients undergoing maintenance dialysis. Electronic databases (CENTRAL, MEDLINE, and Embase) were systematically searched (up to August 2018) for relevant trials. The main outcome was systolic BP reduction.ResultsForty trials (4283 participants) met our inclusion criteria. Angiotensin-converting enzyme inhibitors, β-blockers, calcium-channel blockers, and aldosterone antagonists lowered systolic BP to a greater extent than placebo, with effect sizes ranging from −10.8 mm Hg (95% confidence interval, −14.8 to −6.7 mm Hg) for the aldosterone antagonists to −4.3 mm Hg (95% confidence interval, −7.2 to −1.5 mm Hg) for angiotensin-converting enzyme inhibitors. Aldosterone antagonists and β-blockers were superior to angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium-channel blockers, and renin inhibitors at lowering systolic BP. Compared with angiotensin-converting enzyme inhibitors, aldosterone antagonists and β-blockers lowered systolic BP by 6.4 mm Hg (95% confidence interval, −11.4 to −1.4 mm Hg) and 4.4 mm Hg (95% confidence interval, −7.4 to −1.3 mm Hg), respectively. Systolic BP reduction was not different with angiotensin receptor blockers, α-blockers, and calcium-channel blockers compared with angiotensin-converting enzyme inhibitors. Renin inhibitors were less effective. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and aldosterone antagonists incurred risks of drug discontinuation due to adverse events and hypotension.ConclusionsBP-lowering agents significantly reduced systolic BP in patients undergoing maintenance dialysis. β-Blockers and aldosterone antagonists may confer larger reductions, although treatment with aldosterone antagonists may be limited by adverse events.

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Profil Penggunaan Obat Antihipertensi di RSUD Mas Amsyar Kasongan Kabupaten Katingan

Borneo Journal of Pharmacy ◽

10.33084/bjop.v1i1.248 ◽

2018 ◽

Vol 1 (1) ◽

pp. 47-50

Author(s):

Syahrida Dian Ardhany ◽

Wahyu Pandaran ◽

Mohammad Rizki Fadhil Pratama

Keyword(s):

Prescription Drugs ◽

Enzyme Inhibitors ◽

Antihypertensive Drugs ◽

Angiotensin Converting Enzyme Inhibitors ◽

Channel Blockers ◽

Angiotensin Ii Receptor ◽

Converting Enzyme Inhibitors ◽

Hypertension Patient ◽

Receptor Blockers

Hypertension or high blood pressure is one of the lead causes of death. Hypertension can cause various complications with another disease, even the cause of heart disease, stroke, and kidney disorders. Hypertension is the second rank of the most diseases in Kabupaten Katingan. The purpose of this research is to know the profile of antihypertensive medicines in RSUD Mas Amsyar Kasongan. Method of this research was a descriptive method with saturation sampling used retrospective data on all prescription drugs in 2017. The results of this research based on the patient characteristic were found 43.3% men and 56.7% women, meanwhile 45.8% age < 45 years old and 54.2% for age > 45 years old. The antihypertensive drug items used are propranolol, telmisartan, amlodipine, lisinopril, furosemide, ramipril, valsartan, candesartan, irbesartan, and bisoprolol, meanwhile based on the classification of antihypertensive drugs. are angiotensin II receptor blockers (ARB), diuretics, angiotensin converting enzyme Inhibitors (ACEI), Calcium Channel Blockers (CCB) and alpha 2 adrenergic agonists. Based on the result, it can be concluded that hypertension patient in RSUD Mas Amsyar Kasongan is mostly female (56.7%) and age of hypertension patient is > 45 years old (54.2%). The most antihypertensive prescribed is monotherapy (72%) and the most item of the drug is amlodipine. (38%).

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