Candesartan versus imidapril in hypertension: a randomised study to assess effects of anti-AT1 receptor autoantibodies

Fang, Wei; Jia, Xiujie; Yu, Shuangying; Gu, Ye; Wang, Li; Guo, Xiaomei; Wang, Min; Zhu, Feng; Cheng, Xiang; Wei, Yumiao; Zhou, Zihua; Fu, Michael; Liao, Yuhua

doi:10.1136/hrt.2009.192104

Cited by 37 publications

(27 citation statements)

References 11 publications

(17 reference statements)

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“…A recent report of patients with antibody-mediated rejection because of non-DSA antibodies that bind to angiotensin II type I receptors has also been reported and suggests that AT1 receptor blockers might prevent this newly described type of hypertension. [31][32][33] Hypertension associated with acute rejection responds quite well to treatment of rejection, whereas hypertension not associated with acute rejection often is worsened with the addition of or a dose increase in corticosteroids.…”

Section: Donor Factorsmentioning

confidence: 99%

Assessment and Management of Hypertension in Transplant Patients

Weir

Burgess

Cooper

et al. 2015

Journal of the American Society of Nephrology

149

111

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Hypertension in renal transplant recipients is common and ranges from 50% to 80% in adult recipients and from 47% to 82% in pediatric recipients. Cardiovascular morbidity and mortality and shortened allograft survival are important consequences of inadequate control of hypertension. In this review, we examine the epidemiology, pathophysiology, and management considerations of post-transplant hypertension. Donor and recipient factors, acute and chronic allograft injury, and immunosuppressive medications may each explain some of the pathophysiology of post-transplant hypertension. As observed in other patient cohorts, renal artery stenosis and adrenal causes of hypertension may be important contributing factors. Notably, BP treatment goals for renal transplant recipients remain an enigma because there are no adequate randomized controlled trials to support a benefit from targeting lower BP levels on graft and patient survival. The potential for drugdrug interactions and altered pharmacokinetics and pharmacodynamics of the different antihypertensive medications need to be carefully considered. To date, no specific antihypertensive medications have been shown to be more effective than others at improving either patient or graft survival. Identifying the underlying pathophysiology and subsequent individualization of treatment goals are important for improving long-term patient and graft outcomes in these patients.

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Section: Donor Factorsmentioning

confidence: 99%

Assessment and Management of Hypertension in Transplant Patients

Weir

Burgess

Cooper

et al. 2015

Journal of the American Society of Nephrology

149

111

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“…These AT 1 -AAs appear to be similar in function and specificity as those identified in preeclamptic patients as they also bind to the second extracellular loop of the AT 1 R [26, 28]. The fact that essential hypertensive patients with AT 1 -AAs respond with greater blood pressure reductions to AT 1 R blockade by candesartan than hypertensive individuals without AT 1 -AA [29, 30] suggests a causal role for AT 1 -AAs in at least some cases of hypertension.…”

Section: Protein Targets Of Hypertension-related Antibodiesmentioning

confidence: 99%

Antibodies in the Pathogenesis of Hypertension

Chan

Lieu

Toh

et al. 2014

BioMed Research International

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It has long been known that circulating levels of IgG and IgM antibodies are elevated in patients with essential and pregnancy-related hypertension. Recent studies indicate these antibodies target, and in many cases activate, G-protein coupled receptors and ion channels. Prominent among these protein targets are AT1 receptors, α 1-adrenoceptors, β 1-adrenoceptors, and L-type voltage operated Ca2+ channels, all of which are known to play key roles in the regulation of blood pressure through modulation of vascular tone, cardiac output, and/or Na+/water reabsorption in the kidneys. This suggests that elevated antibody production may be a causal mechanism in at least some cases of hypertension. In this brief review, we will further describe the protein targets of the antibodies that are elevated in individuals with essential and pregnancy-related hypertension and the likely pathophysiological consequences of antibody binding to these targets. We will speculate on the potential mechanisms that underlie elevated antibody levels in hypertensive individuals and, finally, we will outline the therapeutic opportunities that could arise with a better understanding of how and why antibodies are produced in hypertension.

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“…We used losartan, an AT 1 receptor antagonist used to treat hypertention, 18 to demonstrate the presence of AT 1 -AAs in the sera of women with preeclampsia. Our experiments showed that losartan blocked the increase in sEng production and mRNA expression resulting from the treatment with IgG obtained from the sera of the women with preeclampsia.…”

Section: Discussionmentioning

confidence: 99%