Are There Pleiotropic Effects of Antihypertensive Medications or Is It All About the Blood Pressure in the Patient With Diabetes and Hypertension?

Sica, Domenic A.

doi:10.1111/j.1751-7176.2011.00450.x

Cited by 9 publications

(11 citation statements)

References 32 publications

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“…Thus, RAS activity may be a key mechanistic contributor to functional decline in this population. Moreover, in addition to effects in mitigating hypertension, several antihypertensive drugs are also thought to have pleiotropic physiologic effects that extend beyond lowering blood pressure (Sica, 2011; Zoccali and Mallamaci, 2014). For instance, prior work has demonstrated the effects of angiotensin converting enzyme (ACE) inhibitors in endocrine signaling, regulation to tissue-specific oxidative stress and inflammation, and in the regulation of body composition (Carter et al, 2011; Giovannini et al, 2010; Marzetti et al, 2012).…”

Section: Collateral Health Risks Among Older Adults With Hypertensionmentioning

confidence: 99%

Hypertension and aging

Buford

2016

Ageing Research Reviews

411

289

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Hypertension is a highly prevalent condition with numerous health risks, and the incidence of hypertension is greatest among older adults. Traditional discussions of hypertension have largely focused on the risks for cardiovascular disease and associated events. However, there are a number of collateral effects, including risks for dementia, physical disability, and falls/fractures which are increasingly garnering attention in the hypertension literature. Several key mechanisms – including inflammation, oxidative stress, and endothelial dysfunction – are common to biologic aging and hypertension development and appear to have key mechanistic roles in the development of the cardiovascular and collateral risks of late-life hypertension. The objective of the present review is to highlight the multi-dimensional risks of hypertension among older adults and discuss potential strategies for treatment and future areas of research for improving overall care for older adults with hypertension.

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Section: Collateral Health Risks Among Older Adults With Hypertensionmentioning

confidence: 99%

Hypertension and aging

Buford

2016

Ageing Research Reviews

411

289

View full text Add to dashboard Cite

show abstract

“…As previously outlined (29, 30), the choice of first-line antihypertensive medications may have an important role on functional responses after exercise. For instance, ACE inhibitors have been suggested as a promising therapeutic option to target the rate of functional decline, potentially due to pleiotropic effects on body composition, angiogenesis, inflammation and oxidative stress (64,65). In fact, previous evidence has suggested that ACE inhibitors and exercise combined may attenuate declines in gait speed and on limitations of activities of daily-life (15,20,34).…”

Section: Discussionmentioning

confidence: 99%

Angiotensin Converting Enzyme Inhibitors Combined with Exercise for Hypertensive Seniors (The ACES Trial): Study Protocol of a Randomized Controlled Trial

et al. 2020

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Prior evidence suggests that the choice of antihypertensive medication may influence functional status among older adults with hypertension, particularly in conjunction with exercise. In particular, angiotensin converting enzyme (ACE) inhibitors have shown potential to positively influence function. However, randomized, controlled trials are needed to confirm this hypothesis. This paper outlines an RCT designed to determine if choice of first-line antihypertensive medication influences functional and cardiovascular risk factor responses to exercise among older adults with hypertension. Two hundred and thirteen inactive, community-dwelling adults ≥60 years of age with hypertension and functional limitations will be recruited to engage in a 32-week intervention study. Participants will be randomized to one of three first-line antihypertensive agents: (1) the ACE inhibitor perindopril, (2) the AT1 receptor antagonist losartan, or (3) the thiazide diuretic hydrochlorothiazide (HCTZ). Six weeks after randomization, participants will begin a 20-week structured aerobic exercise intervention. Participants will perform two 45-min center-based sessions coupled with 60 min of home-based walking per week. The primary aim is to determine if perindopril improves self-paced gait speed when compared with losartan and HCTZ. The secondary aim is to determine the relative effect of perindopril on secondary outcomes such as: (a) exercise capacity, (b) body mass and composition, and (c) circulating indices of cardiovascular risk. This RCT is expected to identify differential effects of first-line antihypertensive medications when combined with physical exercise thus have potential implications for antihypertensive prescription guidelines for older adults.

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“…20 However, these mild anti-inflammatory effects observed in a small number of patients may not have meaningful impact on stroke rates and CV outcomes if not accompanied by significant BP reduction. 21 One of the main reasons RAS antagonists may be less effective antihypertensive agents in African Americans is the different dose response compared with whites. 22 African Americans require higher doses of ACE inhibitors to achieve equivalent reductions in BP with whites.…”

Section: Discussionmentioning

confidence: 99%

Renin‐Angiotensin System Inhibitors vs Other Antihypertensives in Hypertensive Blacks: A Meta‐Analysis

Palla

Ando

Androulakis

et al. 2016

J of Clinical Hypertension

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The purpose of this study was to assess the effects of reninangiotensin system (RAS) inhibitors vs other antihypertensive agents on cardiovascular outcomes in hypertensive black patients. The authors performed a systematic review and meta-analysis of studies that compared the effects of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) with calcium channel blockers (CCBs), diuretics, and b-blockers in hypertensive black patients on cardiovascular outcomes. A total of 38,983 patients with a mean age of 60 years and mean follow-up of 4 years were included in our meta-analysis. No significant differences were found in all-cause mortality, myocardial infarction, heart failure, and cardiovascular mortality rates among patients treated with RAS inhibitors compared with CCBs, diuretics, and b-blockers. The incidence of stroke was significantly increased in patients treated with RAS inhibitors compared with CCBs (odds ratio, 1.56; 95% confidence interval, 1. Hypertension (HTN) in African Americans is often more severe and resistant to antihypertensive therapy and leads to earlier target organ damage and higher cardiovascular (CV) events compared with whites. [1][2][3] Response to antihypertensive drug classes may be different among different age and race subgroups. Black and elderly patients exhibit better blood pressure (BP) response to thiazide diuretics or long-acting calcium channel blockers (CCBs), provided they don't have a specific indication for angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) such as heart failure (HF) or proteinuric chronic kidney disease. 4 In contrast, younger white patients respond better to ACE inhibitors or ARBs.4-6 The observed differences may be the result of lower plasma renin activity in hypertensive blacks.7 A recent analysis of New York City Health and Hospital Corporation's clinical data showed significantly higher all-cause mortality and myocardial infarction (MI) rates in hypertensive blacks treated with ACE inhibitors. 8 We sought to review and analyze CV outcomes in hypertensive blacks treated with different antihypertensive classes. METHODS Search StrategySystematic electronic search was performed on MED-LINE (PubMed interface), Embase, and Cochrane Central Registry of Controlled Trials (CENTRAL) with no language limitations. Using the MESH terms, we searched the following key terms: hypertension, blacks, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics, and b-blockers. Two reviewers (M.P. and A.B.) independently screened titles and abstracts based on inclusion and exclusion criteria. After eliminating irrelevant studies, full-text reports were reviewed. Review articles were excluded. Subsequently, we performed a hand search of all included randomized clinical trials and observational studies until no further relevant studies were identified. Finally, a total of four studies were identified. Study SelectionWe included randomized clinical trials...

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Are There Pleiotropic Effects of Antihypertensive Medications or Is It All About the Blood Pressure in the Patient With Diabetes and Hypertension?

Cited by 9 publications

References 32 publications

Hypertension and aging

Hypertension and aging

Angiotensin Converting Enzyme Inhibitors Combined with Exercise for Hypertensive Seniors (The ACES Trial): Study Protocol of a Randomized Controlled Trial

Renin‐Angiotensin System Inhibitors vs Other Antihypertensives in Hypertensive Blacks: A Meta‐Analysis

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