4,023 research outputs found
Rationale for triple fixed-dose combination therapy with an angiotensin II receptor blocker, a calcium channel blocker, and a thiazide diuretic
No full textMassimo Volpe,1,2 Giuliano Tocci21Division of Cardiology, Department of Clinical and Molecular Medicine, University of Rome, Sapienza, Sant'Andrea Hospital, Rome, 2IRCCS Neuromed, Pozzilli, ItalyAbstract: Hypertension is a growing global health problem, and is predicted to affect 1.56 billion people by 2025. Treatment remains suboptimal, with control of blood pressure achieved in only 20%–35% of patients, and the majority requiring two or more antihypertensive drugs to achieve recommended blood pressure goals. To improve blood pressure control, the European hypertension guidelines recommend that angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs) are combined with calcium channel blockers (CCBs) and/or thiazide diuretics. The rationale for this strategy is based, in part, on their different effects on the renin-angiotensin system, which improves antihypertensive efficacy. Data from a large number of trials support the efficacy of ACEIs or ARBs in combination with CCBs and/or hydrochlorothiazide (HCTZ). Combining two different classes of antihypertensive drugs has an additive effect on lowering of blood pressure, and does not increase adverse events, with the ARBs showing a tolerability advantage over the ACEIs. Among the different ARBs, olmesartan medoxomil is available as a dual fixed-dose combination with either amlodipine or HCTZ, and the increased blood pressure-lowering efficacy of these two combinations is proven. Triple therapy is required in 15%–20% of treated uncontrolled hypertensive patients, with a renin-angiotensin system blocker, CCB, and thiazide diuretic considered to be a rational combination according to the European guidelines. Olmesartan, amlodipine, and HCTZ are available as a triple fixed-dose combination, and significant blood pressure reductions have been observed with this regimen compared with the possible dual combinations. The availability of these fixed-dose combinations should lead to improvement in blood pressure control and aid compliance with long-term therapy, optimizing the management of this chronic condition.Keywords: angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, triple therapy, hypertensio
Natriuretic peptides and cardio-renal disease.
No full textThe natriuretic peptide (NP) system is an important endocrine, autocrine and paracrine system, consisting of a family of peptides which provide cardiac, renal and vascular effects that, through their beneficial physiological actions, play a key role in maintaining overall cardiovascular health. Traditionally, the pathophysiological origins of cardio-renal disease have been viewed as the domain of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS), with inappropriate activation of both systems leading to deleterious changes in cardio-renal function and structure. Therapies designed to suppress the RAAS and the SNS have been routinely employed to address the consequences of cardio-renal disease. However, it is now becoming increasingly apparent that enhancing the beneficial physiological effects of the NP system may represent an attractive alternative therapeutic approach to counter the pathophysiological effects of disease. In particular, innovative therapeutic strategies aimed at enhancing the physiological benefits afforded by NPs while simultaneously suppressing the RAAS are generating increasing interest as potential treatment options for the management of cardio-renal disease.The natriuretic peptide (NP) system is an important endocrine, autocrine and paracrine system, consisting of a family of peptides which provide cardiac, renal and vascular effects that, through their beneficial physiological actions, play a key role in maintaining overall cardiovascular health. Traditionally, the pathophysiological origins of cardio-renal disease have been viewed as the domain of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS), with inappropriate activation of both systems leading to deleterious changes in cardio-renal function and structure. Therapies designed to suppress the RAAS and the SNS have been routinely employed to address the consequences of cardio-renal disease. However, it is now becoming increasingly apparent that enhancing the beneficial physiological effects of the NP system may represent an attractive alternative therapeutic approach to counter the pathophysiological effects of disease. In particular, innovativ
Olmesartan medoxomil for the treatment of hypertension in children and adolescents
No full textPrevalence of hypertension in children and adolescents has progressively and continuously increased over recent decades. Thus, early and effective control of high blood pressure may be considered an effective therapeutic approach, in order to reduce the burden of hypertension-related cardiovascular disease in future. In the past, due to the absence of prospective, long-term, randomized, controlled clinical trials performed in young hypertensive patients, lifestyle changes have been long seen as the only strategy to reduce high blood pressure levels. More recently, clinical data on the efficacy and safety of five major classes of antihypertensive drugs (including angiotensin converting enzyme inhibitors, angiotensin receptor blockers [ARBs], beta-blockers, calcium-antagonists, and diuretics) have become available. In particular, these trials demonstrated dose-dependent blood pressure reductions and a good tolerability profile of several ARBs in hypertensive children and adolescents. An overview is provided of the clinical benefits of early detection and prompt intervention of high blood pressure levels, with a closer analysis of recent clinical trials, performed with olmesartan medoxomil in young subjects with hypertension. © 2011 Tocci and Volpe, publisher and licensee Dove Medical Press Ltd
Letter by Conti and Volpe regarding article, "Cardiac troponin I but not cardiac troponin T induces severe autoimmune inflammation in the myocardium".
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Preventing cardiovascular events with angiotensin II receptor blockers: A closer look at telmisartan and valsartan
No full textAngiotensin II receptor blockers (ARBs) inhibit the renin-angiotensin system. As a result, these agents provide beneficial effects in terms of cardiovascular (CV) and renal protection, independent of their blood pressure-lowering effects. Telmisartan and valsartan are the most intensively studied ARBs for the effects on CV outcomes. Randomized clinical trials assessing morbidity and mortality end points have included a range of patient types, including those with hypertension, hypertension with Type 2 diabetes, high CV risk without hypertension, ischemic heart disease, stroke and heart failure. Few head-to-head comparisons between telmisartan and valsartan have been performed. However, some blood pressure-independent properties of these two ARBs can be scrutinized from separate studies in the available literature. © 2012 Expert Reviews Ltd
Calcium channel blockers for the clinical management of hypertension
No full textCurrent European guidelines recommend to start antihypertensive therapy with either monotherapy in those individuals with grade 1 hypertension and low-to-moderate
global cardiovascular risk profile, or with dual combination
therapies in those patients with grade 2–3 hypertension or
high-to-very-high global cardiovascular risk profile
High blood pressure & cardiovascular prevention is now on MEDLINE.
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Treatment of systolic hypertension: spotlight on recent studies with angiotensin II antagonists
No full textSystolic blood pressure has a continuous, graded, strong, independent, and aetiologically significant relationship to mortality from coronary heart disease, stroke, and all cardiovascular diseases, as well as to all-cause mortality and life expectancy. Angiotensin II (AII) may be intimately involved in the pathogenesis of systolic hypertension through multiple mechanisms, including decreasing the elastin content and increasing the collagen content of the arterial wall, thickening and fibrotic remodelling of the vascular intima, and proliferating smooth muscle cells in the arterial wall, resulting in increased thickness, stiffening, and partial loss of contractility. AII antagonists may therefore offer hitherto unrecognized benefits ( independent of blood pressure) on age-related vascular damage and provide particular benefits in patients with systolic hypertension. Recent evidence has demonstrated that losartan offers cardiovascular outcomes benefits in isolated systolic hypertension ( ISH) associated with an excellent tolerability profile. This, in patients with ISH, AII antagonists more facilitate systolic BP control, providing cardiovascular protection and offering an excellent risk-benefit profile
Gioacchino Volpe tra passato e presente
No full textRoma, 1-2 dicembre 2005 Biblioteca Nazionale Centrale di Roma (Sala 1) Gioacchino Volpe tra passato e presente Giovedì 1° dicembre ore 9.00 Giuseppe Giarrizzo Volpe tra storiografia e politica: un bilancio Giovanni Aliberti Da Cavour a Giolitti: l’Italia di Croce e di Volpe Mauro Moretti Crivellucci e Volpe: l’esperienza pisana Massimo Mastrogregori Il Medioevo di Volpe e di Bloch Giovedì 1° dicembre ore 15.30 Eugenio Di Rienzo Allievi volpiani tra continuità e innovazione (1945-1962) Emanuel..
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