Article by Disease on “Cardiology”
Objective: We evaluated the safety and efficacy of hypertension management with Coveram (perindopril/amlodipine combination) in patients with uncontrolled blood pressure (BP). All patients were on previous angiotensin receptor blocker (ARB) treatment.
Methods: This was a 3 country, multi-centre (7 cities), open-label, observational study in the Arabian Gulf. Patients (18 years) were recruited between October 2012 and November 2013 and followed-up for 3 months after enrolment. Outcomes included changes in BP from baseline and BP goal attainment rates as per Joint National Committee- 8 (<140/90 mmHg for diabetics and those <60 years of age and <150/90 mmHg for those 60 years of age without diabetes). Medication tolerance was also assessed from both patient and physician perspectives.
Results: Hypertensive patients (n=760; mean age: 51±10 years; 67% were males) were included. A total of 178 patients (23%) were lost to follow-up. The perindopril/amlodipine combination was associated with an overall reduction in systolic BP (SBP) (31 mmHg; p<0.001) and diastolic BP (DBP) (18 mmHg; p<0.001) from baseline. An overall BP control rate was achieved in 87% (n=507) of the participants. There were significant incremental BP reductions with dose up-titration, especially SBP (p<0.001). Those with high SBP (>180 mmHg) at baseline were associated with a mean reduction of 59 mmHg (p<0.001). The perindopril/amlodipine combination had excellent tolerance levels over the study period from both patient and physician perspectives (at 99% and 98%, respectively; p<0.001).
Conclusions: The perindopril/amlodipine combination is an effective and well tolerated anti-hypertensive option in patients on previous ARB treatment.
Dr. Dimitri P. Mikhailidis
Editor-in-Chief: Current Vascular Pharmacology
Academic Head, Department of Clinical Biochemistry,
Royal Free Hospital Campus,
University College London Medical School,
University College London (UCL),
London, NW3 2QG,
The clinical use of sodium glucose co-transporter 2 inhibitors (SGLT2) represents a recent advance in the treatment of diabetes. Accumulating evidence suggests that these drugs may reduce the risk for the development of diabetic nephropathy or reduce the rate of its progression in patients already suffering from this devastating complication. In this manuscript we summarize the available data on the mechanisms that underlie the renoprotective properties of SGLT2 inhibitors. Apart from their beneficial effects on carbohydrate and uric acid metabolism and their blood pressure-lowering properties, the most important mechanism that can explain the reduction in albuminuria and the preservation of renal function that follows their administration is the reduction in intraglomerular pressure. By increasing sodium delivery to the distal parts of the renal tubules, SGLT2 inhibition results in the vasoconstriction of the afferent arteriole thus reducing the intraglomerular pressure and the hyperfiltration that characterizes the early phases of diabetic nephropathy. In addition, the effect of SGLT-2 inhibitors on the renal and the systematic renin-angiotensin axis may also contribute to the observed renoprotection. More specifically, these drugs inhibit the renal renin-angiotensin axis due to increased delivery of sodium to the macula densa. Although the action of renin-angiotensin axis systematically increases, the concomitant use of drugs that modify the function of this system (angiotensin converting enzyme inhibitors and angiotensin receptor II antagonists), that is common in diabetic patients, results in the activation of type I angiotensin receptors that exhibits vasodilative, antiproliferative, antihypertrophic, and antinflammatory actions. Finally, it has been proposed that the reduction in the energy consumption in the proximal tubular cells as well as the shift in energy substrate utilization from glucose to ketone bodies may also increase the viability of renal tissues. In conclusion, SGLT2 inhibitors may represent the drugs of choice for the treatment and the prevention of diabetic nephropathy.
For more information about the article, please visit http://benthamscience.com/journals/current-vascular-pharmacology/article/146173/
Contributed Article: Low-Density Lipoprotein Cholesterol (LDL-C): How Low?
Current Vascular Pharmacology publishes clinical and research-based reviews, original research articles, letters, debates, drug clinical trial studies and guest edited issues to update all those concerned with the treatment of vascular disease, bridging the gap between clinical practice and ongoing research.
Vascular disease is the commonest cause of death in Westernized countries and its incidence is on the increase in the developing countries. It follows that considerable research is directed at establishing effective treatment for acute vascular events. Long-term treatment has also received considerable attention (e.g. for symptomatic relief). Furthermore, effective prevention, whether primary or secondary, is backed by the findings of several landmark trials. Vascular disease is a complex field with primary care physicians and nurse practitioners as well as several specialties involved. The latter include cardiology, vascular and cardio thoracic surgery, general medicine, radiology, clinical pharmacology and neurology (stroke units).
Articles from the journal Current Vascular Pharmacology 15, Issue 2:
- Editorial : Full Blood Count and Peripheral Arterial Disease Severity and Prognosis
- Renoprotective Effects of SGLT2 Inhibitors: Beyond Glucose Reabsorption Inhibition
- Renal Function Impairment in Patients Undergoing Elective EVAR vs. Elective Open Repair During Follow up Period: A Systematic Review of the Literature
- Endovascular vs. Open Repair of Abdominal Aortic Aneurysms and Renal Function
- Re: ‘Re. Renal Function Impairment in Patients Undergoing Elective EVAR vs Elective Open Repair During Follow up Period: A Systematic Review of the Literature’
- Apoptosis and Acute Brain Ischemia in Ischemic Stroke
- Lipoprotein Subfractions, Uric Acid and Cardiovascular Risk in End-Stage Renal Disease (ESRD) Patients
- Metalloproteinase 2 and 9 Activity Increase in Epicardial Adipose Tissue of Patients with Coronary Artery Disease
- High-Density Lipoprotein and Low-Density Lipoprotein Subfractions in Patients with Chronic Kidney Disease
- Hypovitaminosis D is Associated with Endothelial Dysfunction in Patients with Metabolic Syndrome
- Impaired Insulin Sensitivity and Secretion in Patients with Alzheimer’s Disease: The Relationship with Other Atherosclerosis Risk Factors
- Relationships Between Alcohol Consumption, Smoking Status and Food Habits in Greek Adolescents. Vascular Implications for the Future
- Valsartan Protects Against Contrast-Induced Acute Kidney Injury in Rats by Inhibiting Endoplasmic Reticulum Stress-Induced Apoptosis
For details on the articles, please visit this link :: http://bit.ly/2kvbSeJ
Dr. Mansour Sallam
Cardiology Unit, Department of Medicine,
Sultan Qaboos University Hospital,