Combined Therapy with Renin-Angiotensin System and Calcium Channel Blockers in Type 2 Diabetic Hypertensive Patients with Proteinuria

Yılmaz, Mahmut İlker; Carrero, Juan Jesús; Martı́n-Ventura, José Luis; Sönmez, Alper; Sağlam, Mutlu; Çelik, Turgay; Yaman, Halıl; Yenicesu, Müjdat; Eyıleten, Tayfun; Moreno, Juan Antonio; Egido, Jesús; Blanco-Colio, Luís Miguel

doi:10.2215/cjn.01110210

Cited by 68 publications

(70 citation statements)

References 45 publications

(44 reference statements)

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“…In this regard, short-term angiotensin-converting enzyme inhibitor treatment significantly improved endothelial function and normalized both PTX3 and urinary protein excretion in type 2 diabetic proteinuric patients (41). Also, the improvement in FMD after combined therapy with the renin-angiotensin system and calcium channel blockers was independently associated with both PTX3 and sTWEAK normalization in type 2 diabetic hypertensive patients (42). Hence, this study concluded that both PTX3 and sTWEAK levels strongly associate with the endothelial dysfunction typically observed with progressive kidney failure.…”

Section: Discussionmentioning

confidence: 89%

Soluble TWEAK and PTX3 in Nondialysis CKD Patients

Yılmaz

Sönmez

Ortíz

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Chronic kidney disease (CKD) conveys high mortality rates. Soluble TNF-like weak inducer of apoptosis (sTWEAK) and long pentraxin 3 (PTX3) are predictors of mortality in dialysis patients and determinants of endothelial dysfunction. Now, we hypothesize that both sTWEAK and PTX3 act as biomarkers of cardiovascular outcomes in nondialysis CKD patients.Design, setting, participants, & measurements Cross-sectional analysis in which flow-mediated dilation (FMD) and intima-media thickness (IMT) were assessed in 257 nondialysis stage 1 to 5 CKD patients (mean age, 52 Ϯ 12 years; 130 men), together with biochemical measurements and sTWEAK and PTX3 assessments. Patients were followed for cardiovascular outcomes.Results PTX3 and IMT increased, whereas FMD and sTWEAK decreased across CKD stages (P Ͻ 0.001 for all). Both PTX3 and sTWEAK appeared as strong determinants of FMD in multivariate analysis. The univariate associations of sTWEAK and PTX3 with IMT were dependent on estimated GFR. After a median of 39 months (range, 2 to 43 months), 22 fatal and 57 nonfatal cardiovascular events occurred. In a Cox model excluding PTX3, decreasing sTWEAK concentration was associated with increased risk of cardiovascular events independently of basic confounders (age, gender, estimated GFR, C reactive protein, diabetes, and cardiovascular comorbidity) and FMD. In a model excluding sTWEAK, circulating levels of PTX3 were directly associated with cardiovascular outcomes independently of basic confounders, but this association was lost after adjustment for FMD.Conclusions Both PTX3 and sTWEAK levels associated with the endothelial dysfunction observed with progressive kidney failure. Additionally, both biomarkers impacted the predictability of cardiovascular outcomes.

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Section: Discussionmentioning

confidence: 89%

Soluble TWEAK and PTX3 in Nondialysis CKD Patients

Yılmaz

Sönmez

Ortíz

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…In dialysis patients, increased PTX3 levels strongly predicted outcome and did so independently of traditional risk factors and CRP (12)(13)(14)(15). Pharmacologically, short-term angiotensin converting enzyme inhibitor treatment significantly improved flow-mediated dilation while normalizing PTX3 and urinary protein excretion in patients with type 2 diabetes with proteinuria (27), whereas the improvement in flow-mediated dilation after treatment with antihypertensive drugs in diabetic CKD stage 1 patients with hypertension was independently associated with PTX3 normalization (28). Altogether, these results suggest that increased PTX3 may play a role in the pathogenesis of endothelial dysfunction/cardiovascular disease.…”

Section: Discussionmentioning

confidence: 91%

Inverse Relationship between the Inflammatory Marker Pentraxin-3, Fat Body Mass, and Abdominal Obesity in End-Stage Renal Disease

Miyamoto

Qureshi

Heimbürger

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives belongs to the same pentraxin superfamily of acute-phase reactants as C-reactive protein (CRP). Abdominal fat accumulation in ESRD is considered a chronic inflammatory state, but the relationship of PTX3 to this phenomenon is unknown. This study assesses plausible associations between PTX3 and surrogates of fat mass deposits in dialysis patients.Design, setting, participants, & measurements Circulating levels of PTX3, CRP, and IL-6 were cross-sectionally analyzed in relation to anthropometric and nutritional surrogate markers of fat tissue in two cohorts comprising 156 prevalent hemodialysis (HD) and 216 incident dialysis patients. ResultsIn both cohorts, PTX3 was negatively associated with body mass index (BMI) and fat body mass index (FBMI) derived from anthropometrics and leptin, whereas there was a positive association with adiponectin. In prevalent HD patients, those with larger waist circumference (above gender-specific median values) had lower PTX3, higher CRP, and higher IL-6 levels. This was also true in multivariate analyses. In both cohorts, multivariate regression analyses showed that PTX3 was negatively and CRP (or IL-6) was positively associated with FBMI.Conclusions Although CRP and IL-6 were directly associated with body fat, PTX3 levels showed negative correlations with surrogates of adipose tissue in two independent cohorts of ESRD patients. Understanding the underlying reasons behind these opposite associations may have clinical relevance given the survival advantage described for obese patients on dialysis.

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“…Our study reveals that PTX3 levels increases up to 15 times than the upper limit of the normal range in hypertensive patients. Yılmaz et al (18,19) investigated PTX3 levels in type 2 diabetic patients with proteinuria and demonstrated a slight increase in both hypertensive and normotensive patients. Therefore it is interesting that PTX3 levels in diabetic patients of the mentioned study is lesser increased than the levels of isolated hypertensive patients in our study.…”

Section: Discussionmentioning

confidence: 99%

Elevated pentraxin-3 levels are related to blood pressure levels in hypertensive patients: an observational study

Parlak¹,

Aydoğan²,

İyisoy³

et al. 2012

Anadolu Kardiyol Derg

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Objective: In this study, relationship between systolic and diastolic blood pressure and pentraxin-3 (PTX3) levels in hypertensive patients was investigated. Methods: Overall, 80 patients with stage 1 hypertension between 40-61 years of age without any disease and 80 healthy volunteers were included to the study. Blood samples obtained to measure PTX3 levels and biochemical analysis. Relationship between PTX3 levels and clinical and biochemical parameters were analyzed using multivariate regression analysis. Results: Although systolic and diastolic blood pressures were significant different, there were no differences regarding age and gender between hypertensives and normotensives. In each group, significant statistical differences were found between PTX3 and CRP levels (PTX3 (ng/mL) 35.25±5.45 and 0.27±0.24, p<0.001; CRP (mg/dL) 10.03±5.81 and 4.30±3.38, p<0.001; in hypertensive and normotensive groups respectively). It was observed that increase in PTX3 levels accompanies the increase in systolic and diastolic blood pressures (r 2 =0.78). It was observed that PTX3 levels are not effected from CRP, lipid levels and body mass index (p>0.05). On multivariate regression analysis PTX3 was found to strongly affect blood pressure (beta=0.82, 95% CI 0.644-0.799, p<0.001, and beta=0.84, 95% CI 0.422-0.799, p<0.001, respectively for systolic and diastolic blood pressures), CRP and total cholesterol are found to affect moderately (beta=0. p<0.05, respectively). Conclusion: This study showed that PTX3 levels are higher in newly diagnosed hypertensive patients than in healthy individuals. In addition, it was noticed that increased PTX3 levels causes increase in systolic and diastolic blood pressures. (

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Combined Therapy with Renin-Angiotensin System and Calcium Channel Blockers in Type 2 Diabetic Hypertensive Patients with Proteinuria

Cited by 68 publications

References 45 publications

Soluble TWEAK and PTX3 in Nondialysis CKD Patients

Soluble TWEAK and PTX3 in Nondialysis CKD Patients

Inverse Relationship between the Inflammatory Marker Pentraxin-3, Fat Body Mass, and Abdominal Obesity in End-Stage Renal Disease

Elevated pentraxin-3 levels are related to blood pressure levels in hypertensive patients: an observational study

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