Pushing the Limits of Medical Management in HCM: A Review of Current Pharmacological Therapy Options

Hypertrophic cardiomyopathy (HCM) is the most common monogenic cardiac disease with a highly variable phenotypic expression, ranging from asymptomatic to drug refractory heart failure (HF) presentation. Pharmacological therapy is the first line of treatment, but options are currently limited to nonspecific medication like betablockers or calcium channel inhibitors, with frequent suboptimal results. While being the gold standard practice for the management of drug refractory HCM patients, septal reduction therapy (SRT) remains an invasive procedure with associated surgical risks and it requires the expertise of the operating centre, thus limiting its accessibility. It is therefore with high interest that researchers look for pharmacological alternatives that could provide higher rates of success. With new data gathering these past years as well as the development of a new drug class showing promising results, this review provides an up-to-date focused synthesis of existing medical treatment options and future directions for HCM pharmacological treatment.

State of the dentoalveolar system in children from mothers with gestational hypertension

Development of diagnostic and practical criteria for arterial hypertension and complications in children from mothers with gestational hypertension against the background of the use of calcium channel inhibitors. In 2018, new European recommendations on cardiovascular diseases during pregnancy and European recommendations on arterial hypertension were published, which have special sections on hypertension in pregnant women. The recommendations draw attention to the fact that hypertensive disorders during pregnancy are the most common medical complications affecting 5-10% of pregnancies worldwide, and remain the main cause of maternal, fetal and neonatal morbidity and mortality. The fetus is at high risk of intrauterine growth retardation (25% of cases in preeclampsia (PE), prematurity (27% of cases in PE), and intrauterine death (4% of cases in PE). Women with a high or moderate risk of developing PE are recommended to take 100-150 mg of acetylsalicylic acid daily between 12 and 36-37 weeks of pregnancy (recommendation class 1, evidence level A). In addition, to prevent PE in women with low calcium intake (<600 mg/day), it is recommended to introduce calcium into the diet (1.5-2 g/day, orally), which should begin after the first visit to the women's consultation. The recommendations specifically draw attention to the fact that vitamins C and E do not reduce the risk of PE.

Mibefradil and Flunarizine, Two T-Type Calcium Channel Inhibitors, Protect Mice against Lipopolysaccharide-Induced Acute Lung Injury

Recent studies have illuminated that blocking Ca2+ influx into effector cells is an attractive therapeutic strategy for lung injury. We hypothesize that T-type calcium channel may be a potential therapeutic target for acute lung injury (ALI). In this study, the pharmacological activity of mibefradil (a classical T-type calcium channel inhibitor) was assessed in a mouse model of lipopolysaccharide- (LPS-) induced ALI. In LPS challenged mice, mibefradil (20 and 40 mg/kg) dramatically decreased the total cell number, as well as the productions of TNF-α and IL-6 in bronchoalveolar lavage fluid (BALF). Mibefradil also suppressed total protein concentration in BALF, attenuated Evans blue extravasation, MPO activity, and NF-κB activation in lung tissue. Furthermore, flunarizine, a widely prescripted antimigraine agent with potent inhibition on T-type channel, was also found to protect mice against lung injury. These data demonstrated that T-type calcium channel inhibitors may be beneficial for treating acute lung injury. The important role of T-type calcium channel in the acute lung injury is encouraged to be further investigated.

State of the dentoalveolar system in children from mothers with gestational hypertension

Development of diagnostic and practical criteria for arterial hypertension and complications in children from mothers with gestational hypertension against the background of the use of calcium channel inhibitors. In 2018, new European recommendations on cardiovascular diseases during pregnancy and European recommendations on arterial hypertension were published, which have special sections on hypertension in pregnant women.

Gabapentinoid prescription in oral medicine and oral surgery practice. Part I − Experience from a French Orofacial pain clinic

Gabapentinoids, pregabalin and gabapentin, are neuronal voltage-gated calcium channel inhibitors mainly prescribed for the treatment of partial epilepsy and neuropathic pain. Although their efficacy as first-line treatments for painful neuropathic conditions (and several non-neuropathic painful conditions) has been well established in general medical practice, their efficacy and prescription in Oral Medicine and Oral Surgery practice has received little attention so far. This didactic article, the first of a two-part series, aims to present the experience of a French tertiary orofacial pain clinic regarding the prescription of gabapentinoids in Orofacial pain conditions that fall within the scope of the oral surgeon's practice.