The Chemical Compounds of Flacourtia rukam Leaves and Their Inhibition of Angiotensin-converting Enzyme (ACE) Activity

Flacourtia rukam is a plant popular among people to treat hypertension, especially the Musi Banyuasin of south Sumatera, Indonesia. Isolation and identification of chemical compounds from F. rukam leaves and evaluation of their effects on antihypertensive activity have been conducted. Isolation of chemical compounds using chromatographic methods and identification using spectroscopic methods were compared with the reported data. The drug’s effects on antihypertension were determined using the angiotensin converting enzyme (ACE) inhibitory method. Two compounds were first reported and isolated from the leaves of F. rukam and identified as apigenin (1) and lupeol (2). These compounds were demonstrated to be effective in treating antihypertension with IC50 656.51 ± 1.55 µg/mL for apigenin and 15.12 ± 0.72 µg/mL for lupeol. It can be concluded that F. rukam leaves is a potential ACE inhibitor can be explored further as an effective antihypertensive agent.

The Potency of Bovine Bone Gelatin as Antihypertensive Agent: A Review

This review was purposed to understand the effectiveness of bovine bone gelatin as an antihypertensive agent. This review concerning the effectiveness of bovine bone gelatin as an antihypertensive agent. Hypertension, also called as a silent disease, has become the main cause of coronary heart disease and stroke that contributes to the malfunction of human organs. Changes of lifestyle alongside with science enhancement, provides new inventions regarding methods of hypertension therapy by minimizing the use of synthetic drugs. Collagen tissue of bovine bone gelatin is known to contain angiotensin converting enzyme (ACE) inhibitor, an active peptide that plays a role in lowering blood pressure supporting with the large amount of Gly (27%), Pro (17.6%), and Hyp (14.4%) and repeating pattern of Gly-X-Y. A study was carried out in vivo using injected spontaneously hypertensive rats (SHR) with 30 mg/kg and was able to reduce blood pressure by 15 mmHg. Antihypertensive test with SHR tail-cuff at 30 mg/kg bovine gelatin hydrolysate RGL-(Hyp)-GL and RGM-(Hyp)-GF were 31.3 mmHg and 38.6 mmHg respectively. A study conducted using bovine and porcine gelatin with 30–50 kDa (permeate P1) and 1–2 kDa (permeate P3) was able to reduce blood pressure by 22 mmHg and 21.33 mmHg. In addition, it is still possible conducting research to find out other peptides of bovine bone gelatin that can be used as a future alternative antihypertensive agent.

Hydralazine-induced liver injury: a review and discussion

Hydralazine is a commonly prescribed antihypertensive agent. Some of its labelled adverse reactions include lupus-like syndrome, tachycardia, headache and fever. Despite its well-known side effects, little is known about hydralazine’s hepatotoxic effects. We report the case of a 54-year-old female patient who was started on hydralazine for hypertension management but later presented with hydralazine-induced liver injury. Her initial presentation consisted of non-specific symptoms and a hepatocellular injury pattern. Liver biopsy revealed hepatic steatosis. Three weeks after discontinuation of hydralazine, the patient’s liver enzymes normalised, and her symptoms resolved. Few studies have examined the incidence and mechanism by which hydralazine induces a liver injury pattern. With this case, we review the literature, the pathogenesis involved and the eventual management of hydralazine-induced liver injury. We propose close monitoring of liver enzymes for patients on hydralazine throughout their treatment course.

Survey on common practice in management of preeclampsia by obstetricians

Background: Approximately 72,000 pregnant women all over the world die every year due to direct or indirect complications related to eclampsia and severe preeclampsia. Incidence of hypertensive disorders in pregnancy in India is found to be 10.08% as per the data collected by the National Eclampsia Registry (NER). Here we present the results of a survey conducted among obstetricians in India to know the common practices in the management of pre-eclampsia followed in our country.Methods: Observational study of survey which was conducted for the period of 1 month from 22nd May 2020 to 22nd April 2020. Questionnaire was prepared on surveyheart.com and sent to obstetricians via Social media platforms to the members of FOGSI. all answers 'collected' and results were prepared from given answers. The survey was answered online by 289 obstetricians.Results: For mild to moderate pre-eclampsia Labetalol is still first line antihypertensive agent being used by many of the obstetricians. In our study also we found out Tab Labetalol 100mg BD is the most preferred type (278, 96.19%) of first line anti-hypertensive in cases of pre-eclampsia followed by Cap Nifedipine 5mg QID and Tab Amlodipine 5mg OD respectively.Conclusions: Comprehensive educational efforts and skill building modules are need of hour to keep every practicing obstetrician regarding recent advances in standard practice protocols.With close monitoring of all cases and well selected anti-hypertensive treatment, it is possible to achieve favourable outcomes for the mother and the baby.

POTENSI INTERAKSI OBAT AMLODIPIN PADA PASIEN HIPERTENSI DISALAH SATU PUSKESMAS KABUPATEN SUMEDANG

Hypertension is still a main health problem in indonesia, the purpose of this research is to know the profile of the antihypertensive agent and the interaction potency of the drugs and the relation between the amount of the drugs towards the interaction occurrence in public health centre of sukasari in district of sumedang by the period of July-December 2019. This was observational research with descriptive method. The data collection was performed using drug interaction checker software. There are data of 112 patients. The analysis was performed quantitatively and qualitatively. the result shows the interaction occurrence are happened to woman with percentage of 90% in age group of 65-74 years (30%). Hypertension stage 2 is the most occurred (69%), also there are 82 (73%) patients with potentially might have interaction, meanwhile from all medicines, there are 116 occurrence of interatction might happen. The most interaction occurred happen to amlodipin and hycrochlorothiazide (41%), with pharmacodynamic interaction of 62% and minor severity of 62%.

The antihypertensive agent hydralazine reduced extracellular matrix synthesis and liver fibrosis in nonalcoholic steatohepatitis exacerbated by hypertension

Hypertension is an important risk factor for nonalcoholic steatohepatitis. We have previously demonstrated that hypertensive rats fed a high fat and cholesterol (HFC) diet incurred a more severe hepatic inflammatory response and fibrosis. Here we investigated the role of hypertension in NASH by comparing HFC-induced hepatic fibrogenesis between spontaneously hypertensive rats (SHRs) and their normotensive Wistar Kyoto counterpart. Compared to the counterpart, the HFC diet led to stronger aggregation of CD68-positive macrophages in SHRs. HFC feeding also resulted in significantly higher upregulation of the fibrosis-related gene alpha-smooth muscle actin in SHR. The HFC diet induced higher overexpression of serum tissue inhibitor of metalloproteinase-1 (TIMP1) and greater suppression of matrix metalloproteinase-2 (MMP2):TIMP1, MMP8:TIMP1, and MMP9:TIMP1 ratios, as a proxy of the activities of these MMPs in SHR. Administration of the antihypertensive agent hydralazine to SHRs significantly ameliorated HFC-induced liver fibrosis; it suppressed the aggregation of CD68-positive macrophages and the upregulation of platelet-derived growth factor receptor beta, and collagen, type 1, alpha-1 chain. In conclusion, a hypertensive environment exacerbated the hepatic fibrogenetic effects of the HFC diet; while the effects were partially reversed by the antihypertensive agent hydralazine. Our data suggest that antihypertensive drugs hold promise for treating NASH exacerbated by hypertension.

Association of antihypertensive agents with the risk of in-hospital death in patients with Covid-19

ABSTRACTIn this retrospective multicenter cohort study, we aimed to investigate the association between antihypertensive agent exposure and in-hospital mortality in patients with Covid-19. Of 8,078 hospitalized patients for Covid-19, 3,686 (45.6%) had hypertension including 2043 (55.4%) patients exposed to a renin-angiotensin-aldosterone inhibitors (RAASi), 1624 (44.1%) to calcium channel blockers (CCB) and 1154 (37.7%) to beta-blockers. Overall in-hospital 30-day mortality was 23.1%. Compared to non-users, the risk of mortality was lower in CCB (aOR, 0.83 [0.70-0.99]) and beta-blockers users (aOR, 0.80 [0.67-0.95]), and not different in RAASi users. These findings support the continuation of antihypertensive agents in patients with Covid-19.