Antihypertensive monotherapy with nisoldipine CC is superior to enalapril in black patients with severe hypertension

RADEVSKI, I; Skudicky, Daniel; Candy, Geoffrey P.; Sathekge, Sewela; Strugo, Victor; Sareli, Pinhas

doi:10.1016/s0895-7061(98)00233-7

Cited by 36 publications

(15 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…37,74,75 In a second South African study, another CCB decreased ambulatory BP and left ventricular mass, whereas enalapril monotherapy decreased neither BP nor left ventricular mass. 76 In Nigeria, diuretics appear to be less efficient antihypertensives than are CCBs. 77 Of note, combination therapy was often required.…”

Section: Choice Of Agentmentioning

confidence: 99%

Hypertension in Sub-Saharan African Populations

2005

View full text Add to dashboard Cite

Background-Hypertension in sub-Saharan Africa is a widespread problem of immense economic importance because of its high prevalence in urban areas, its frequent underdiagnosis, and the severity of its complications. Methods and Results-We searched PubMed and relevant journals for words in the title of this article. Among the major problems in making headway toward better detection and treatment are the limited resources of many African countries. Relatively recent environmental changes seem to be adverse. Mass migration from rural to periurban and urban areas probably accounts, at least in part, for the high incidence of hypertension in urban black Africans. In the remaining semirural areas, inroads in lifestyle changes associated with "civilization" may explain the apparently rising prevalence of hypertension. Overall, significant segments of the African population are still afflicted by severe poverty, famine, and civil strife, making the overall prevalence of hypertension difficult to determine. Black South Africans have a stroke rate twice as high as that of whites. Two lifestyle changes that are feasible and should help to stem the epidemic of hypertension in Africa are a decreased salt intake and decreased obesity, especially in women. Conclusions

show abstract

Section: Choice Of Agentmentioning

confidence: 99%

Hypertension in Sub-Saharan African Populations

2005

View full text Add to dashboard Cite

show abstract

“…[2][3][4][5][6][7] In addition, these agents are not very effective in some patients, particularly African Americans, in whom high blood pressure (BP) is associated with low renin levels and a response to salt depletion. 8,9 The development of new classes of antihypertensive agents with different mechanisms of action, therefore, remains an important goal. In this way, because a brain RAS hyperactivity has been implicated in the development and maintenance of hypertension, 10 -13 its components could constitute interesting targets.…”

mentioning

confidence: 99%

Orally Active Aminopeptidase A Inhibitors Reduce Blood Pressure

et al. 2008

View full text Add to dashboard Cite

Abstract-Overactivity of the brain renin-angiotensin system has been implicated in the development and maintenance of hypertension. We reported previously that angiotensin II is converted to angiotensin III by aminopeptidase A in the mouse brain. We then used specific and selective aminopeptidase A inhibitors to show that angiotensin III is one of the main effector peptides of the brain renin-angiotensin system, exerting tonic stimulatory control over blood pressure in hypertensive rats. Aminopeptidase A, the enzyme generating brain angiotensin III, thus represents a potential candidate central nervous system target for the treatment of hypertension. Given this possible clinical use of aminopeptidase A inhibitors, it was, therefore, important to investigate their pharmacological activity after oral administration. We investigated RB150, a dimer of the selective aminopeptidase A inhibitor, EC33, generated by creating a disulfide bond. This chemical modification allows prodrug to cross the blood-brain barrier when administered by systemic route. Oral administration of RB150 in conscious DOCA-salt rats inhibited brain aminopeptidase A activity, resulting in values similar to those obtained with the brains of normotensive rats, demonstrating the central bioavailability of RB150. Oral RB150 treatment resulted in a marked dose-dependent reduction in blood pressure in DOCA-salt but not in normotensive rats, with an ED 50 in the 1-mg/kg range, achieved in Ͻ2 hours and lasting for several hours. This treatment also significantly decreased plasma arginine-vasopressin levels and increased diuresis, which may participate to the blood pressure decrease by reducing the size of fluid compartment. Thus, RB150 may be the prototype of a new class of centrally active antihypertensive agents. Key Words: aminopeptidase A inhibitors Ⅲ blood pressure Ⅲ brain renin-angiotensin system Ⅲ DOCA-salt rats Ⅲ hypertension H ypertension is a major cardiovascular risk factor, affecting Ϸ20% of the adult population, of which 95% have essential hypertension. Blockers of the systemic renin-angiotensin system (RAS), angiotensin (Ang) I-converting enzyme (ACE; EC 3.4.15.11) inhibitors or Ang II receptor type 1 (AT 1 ) antagonists, have since been shown to be efficient and safe for treating hypertension. 1 However, they may cause secondary effects, such as coughing, deterioration of renal function in cases of underlying renal artery stenosis, and, more rarely, angioedema. [2][3][4][5][6][7] In addition, these agents are not very effective in some patients, particularly African Americans, in whom high blood pressure (BP) is associated with low renin levels and a response to salt depletion. 8,9 The development of new classes of antihypertensive agents with different mechanisms of action, therefore, remains an important goal. In this way, because a brain RAS hyperactivity has been implicated in the development and maintenance of hypertension, 10 -13 its components could constitute interesting targets. Among the bioactive peptides of the brain RAS, Ang I...

show abstract

“…Moreover, the most frequently reported AEs in both groups were headache, nasopharyngitis and dizziness, events that are commonly observed in studies of antihypertensive drugs in patients with severe hypertension. [21][22][23] Aliskiren-based treatment did not result in any significant changes in laboratory or biochemistry values. Despite ACE inhibitors being commonly associated with a dry non-productive cough (5-35% of patients), the incidence of cough following lisinopril-based treatment was unusually low in this study (2%).…”

Section: Discussionmentioning

confidence: 82%

A comparison of the tolerability of the direct renin inhibitor aliskiren and lisinopril in patients with severe hypertension

et al. 2007

View full text Add to dashboard Cite

Patients with severe hypertension (4180/110 mm Hg) require large blood pressure (BP) reductions to reach recommended treatment goals (o140/90 mm Hg) and usually require combination therapy to do so. This 8-week, multicenter, randomized, double-blind, parallelgroup study compared the tolerability and antihypertensive efficacy of the novel direct renin inhibitor aliskiren with the angiotensin converting enzyme inhibitor lisinopril in patients with severe hypertension (mean sitting diastolic blood pressure (msDBP)X105 mm Hg and o120 mm Hg). In all, 183 patients were randomized (2:1) to aliskiren 150 mg (n ¼ 125) or lisinopril 20 mg (n ¼ 58) with dose titration (to aliskiren 300 mg or lisinopril 40 mg) and subsequent addition of hydrochlorothiazide (HCTZ) if additional BP control was required. Aliskiren-based treatment (ALI) was similar to lisinoprilbased treatment (LIS) with respect to the proportion of patients reporting an adverse event (AE; ALI 32.8%; LIS 29.3%) or discontinuing treatment due to AEs (ALI 3.2%; LIS 3.4%). The most frequently reported AEs in both groups were headache, nasopharyngitis and dizziness. At end point, ALI showed similar mean reductions from baseline to LIS in msDBP (ALI À18.5 mm Hg vs LIS À20.1 mm Hg; mean treatment difference 1.7 mm Hg (95% confidence interval (CI) À1.0, 4.4)) and mean sitting systolic blood pressure (ALI À20.0 mm Hg vs LIS À22.3 mm Hg; mean treatment difference 2.8 mm Hg (95% CI À1.7, 7.4)). Responder rates (msDBPo90 mm Hg and/or reduction from baselineX10 mm Hg) were 81.5% with ALI and 87.9% with LIS. Approximately half of patients required the addition of HCTZ to achieve BP control (ALI 53.6%; LIS 44.8%). In conclusion, ALI alone, or in combination with HCTZ, exhibits similar tolerability and antihypertensive efficacy to LIS alone, or in combination with HCTZ, in patients with severe hypertension.

show abstract

Antihypertensive monotherapy with nisoldipine CC is superior to enalapril in black patients with severe hypertension

Cited by 36 publications

References 31 publications

Hypertension in Sub-Saharan African Populations

Hypertension in Sub-Saharan African Populations

Orally Active Aminopeptidase A Inhibitors Reduce Blood Pressure

A comparison of the tolerability of the direct renin inhibitor aliskiren and lisinopril in patients with severe hypertension

Contact Info

Product

Resources

About