Effect of antihypertensive treatments on insulin signalling in lympho-monocytes of essential hypertensive patients: A pilot study

Ciuceis, Carolina De; Flati, Vincenzo; Rossini, Claudia; Rufo, Anna; Porteri, Enzo; Gregorio, Jacopo Di; Petroboni, Beatrice; Boria, Elisa La; Donini, C.; Pasini, Evasio; Rosei, Enrico Agabiti; Rizzoni, Damiano

doi:10.3109/08037051.2014.901021

Cited by 6 publications

(3 citation statements)

References 33 publications

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“…While studies have reported anti-inflammatory effects of ARBs beyond their blood pressure-lowering effects, 50–52 we did not observe any overall, six-week impact of telmisartan on circulating inflammatory biomarkers or peripheral T lymphocyte or monocyte activation. One explanation for this finding may be the short treatment period of this study, as most clinical studies have demonstrated anti-inflammatory benefits after 3–6 months of treatment.…”

Section: Discussioncontrasting

confidence: 87%

Telmisartan to reduce cardiovascular risk in older HIV-infected adults: a pilot study

Lake

Seang

Kelesidis

et al. 2015

HIV Clinical Trials

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Background HIV-infected persons are at increased cardiovascular disease (CVD) risk, but traditional CVD therapies are understudied in this population. Telmisartan is an angiotensin receptor blocker and PPAR-γ agonist that improves endothelial function and cardiovascular mortality in HIV-uninfected populations. We assessed the effects of telmisartan on endothelial function in older HIV-infected persons at risk for CVD in a small pilot study. Methods HIV-infected individuals ≥50 years old on suppressive antiretroviral therapy (ART) with ≥1 traditional CVD risk factor received open label telmisartan 80 mg daily for six weeks. Brachial artery flow-mediated dilation (FMD) measured endothelial function. The primary endpoint was six-week change in maximum relative FMD. Results Seventeen participants enrolled; 16 completed all evaluations (88% men, 65% non-White, median age 60 years, CD4+ T lymphocyte count 625 cells/mm3). ART included 71% PI, 29% NNRTI, 29% integrase inhibitor, 65% tenofovir and 29% abacavir. CVD risk factor prevalence included 76% hyperlipidemia, 65% hypertension, 18% smoking and 12% diabetes mellitus. After six weeks, statistically significant blood pressure changes were observed (systolic −16.0 mmHg, diastolic −6.0 mmHg) without significant changes in FMD. In subset analyses, FMD increased more among abacavir-treated, PI-treated and non-smoking participants. Conclusions No significant FMD changes were observed after six weeks of telmisartan therapy; however, abacavir- and PI-treated participants and non-smokers showed greater FMD increases. Additional studies are needed to explore the effects of telmisartan on endothelial function among HIV-infected individuals with traditional CVD and/or ART-specific risk factors.

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Section: Discussioncontrasting

confidence: 87%

Telmisartan to reduce cardiovascular risk in older HIV-infected adults: a pilot study

Lake

Seang

Kelesidis

et al. 2015

HIV Clinical Trials

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“…Increased cellular expression of glucose transporter type 4 was observed with the lercanidipine/enalapril combination compared to lercanidipine/hydrochlorothiazide 54. Activating insulin signaling in human lymphomonocytes may have an important role in patients with diabetes, suggesting that CCB-based drug combinations are more preferable in obese patients or patients with diabetes because of their effects in insulin sensitivity 55. Arterial stiffness and augmentation index were studied in hypertensive patients with metabolic syndrome in a study that compared the effect of combination therapy with an ACE inhibitor plus CCB or thiazide diuretic on these parameters.…”

Section: Metabolic Actions Of the Fixed Combinationmentioning

confidence: 99%

Combination therapy with lercanidipine and enalapril in the management of the hypertensive patient: an update of the evidence

Antza

Stabouli

Kotsis

2016

VHRM

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Hypertension is an important risk factor for premature death as it increases the probability of stroke, myocardial infarction, and heart failure. Antihypertensive drugs can decrease cardiovascular (CV) morbidity and mortality. The majority of hypertensive patients need more than one antihypertensive agent to attain blood pressure (BP) targets. Monotherapy can effectively reduce BP only in 20%–40% of patients. Multiple mechanisms including increased peripheral vascular resistance, increased cardiac work, and hypervolemia are involved in the pathogenesis of hypertension. Targeting multiple pathways may more potently reduce BP. Increasing the dose of a single agent in many cases does not provide the expected BP-lowering effect because the underlying mechanism of the BP increase is either different or already corrected with the lower dose. Moreover, drugs acting on different pathways may have synergistic effects and thus better control hypertension. It is well known that diuretics enhance the actions of renin–angiotensin aldosterone system and activate it as a feedback to the reduced circulated blood volume. The addition of a renin–angiotensin aldosterone system blocker to a diuretic may more effectively reduce BP because the system is upregulated. Reducing the maximal dose of an agent may also reduce possible side effects if they are dose dependent. The increased prevalence of peripheral edema with higher doses of calcium channel blockers (CCBs) is reduced when renin–angiotensin aldosterone system blockers are added to CCBs through vein dilation. The effectiveness of the combination of enalapril with lercanidipine in reducing BP, the safety profile, and the use of the combination of angiotensin-converting enzyme inhibitors with CCBs in clinical trials with excellent CV hard end point outcomes make this combination a promising therapy in the treatment of hypertension.

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“…This peculiar property is documented by the finding that during a 6-month treatment with this drug combination, an increased expression of insulin receptor glucose transporter 4 and an increased activation of the Chinese p70-S6K1 could be detected. 40 However, assessment of the effects of lercanidipine/enalapril combination on the metabolic profile of the obese or overweight hypertensive patient is not limited to insulin resistance. Indeed, data collected in the aforementioned study as well as in other studies provided evidence that this drug combination significantly increases plasma high-density lipoprotein cholesterol values, concomitantly reducing circulating plasma triglycerides as well as plasma lipoprotein-a levels.…”

Section: Comparative Studies With Other Drug Combinationsmentioning

confidence: 99%

Lercanidipine/enalapril combination in the management of obesity-related hypertension

Grassi

2016

IBPC

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Obesity-related hypertension represents a condition frequently observed in current clinical practice characterized by a complex pathophysiological background and a very high cardiovascular risk profile, particularly in severely obese individuals. This explains, on the one hand, the difficulty in reducing elevated blood pressure values in this pathological state and, on the other, the need to achieve this goal in a relatively short-time period to prevent the occurrence of fatal and nonfatal cardiovascular events. Both nonpharmacological and pharmacological measures are available in the therapeutic approach for this condition. Among the pharmacological interventions, a combination of two antihypertensive drugs represents the most common recommended strategy aimed at achieving blood pressure control. This paper, after briefly examining the main pathophysiological features of obesity-related hypertension, will review the importance in the treatment of this condition of the drug combination based on a calcium channel blocker and an angiotensin-converting enzyme inhibitor, with specific focus on lercanidipine/enalapril. Following an analysis of the main pharmacological properties of the combination, the results of the studies based on this pharmacological approach in obesity-related hypertension will be critically discussed. The efficacy, safety, and tolerability profile of the lercanidine/enalapril drug combination as well as its potential limitations will also be examined.

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Effect of antihypertensive treatments on insulin signalling in lympho-monocytes of essential hypertensive patients: A pilot study

Cited by 6 publications

References 33 publications

Telmisartan to reduce cardiovascular risk in older HIV-infected adults: a pilot study

Telmisartan to reduce cardiovascular risk in older HIV-infected adults: a pilot study

Combination therapy with lercanidipine and enalapril in the management of the hypertensive patient: an update of the evidence

Lercanidipine/enalapril combination in the management of obesity-related hypertension

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