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Losartan was the first angiotensin AT1 receptor blocker (ARB) approved by US Food and Drug Administration (FDA) for the treatment of hypertension. In addition to its established antihypertensive and end organ effects, several benefits of losartan beyond its antihypertensive effect have been demonstrated in clinical trials. Apart from its class effects of ARBs, losartan has pharmacokinetic and pharmacodynamic properties that are unique to it. It has shown considerable benefits as uricosuric agent, in erectile dysfunction and in prevention of stroke in hypertension patients with left ventricular hypertrophy. This review presents the benefits of losartan beyond being a hypertensive agent and associated clinical outcomes.
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［Abstract］Objective:To evaluate the efficacy and safety of fermented cordyceps powder combined with angiotensin-converting enzyme inhibitors （ACEI）/angiotensin Ⅱ receptor blocker （ARB） in the treatment of diabetic kidney disease （DKD）. Method:The randomized controlled trials （RCTs） concerning the treatment of DKD with fermented cordyceps powder plus ACEI/ARB were retrieved from Pubmed， Embase， Cochrane library， China National Knowledge Infrastructure （CNKI）， Chinese BioMedical Literature Database on disc （CBMdisc）， Wanfang Data Knowledge Service Platform， and Chongqing Weipu Database for Chinese Technical Periodicals （VIP）. The quality of the included articles was evaluated by the Cochrane Collaboration's tool， followed by data analysis using RevMan 5.3. Result:A total of 48 RCTs were included， involving 4 562 cases. As revealed by Meta-analysis， the effective rate of fermented cordyceps powder combined with ACEI/ARB was higher than that of ACEI/ARB ［risk ratio （RR）=1.20， 95% confidence interval （CI） （1.15，1.24）， <italic>P</italic><0.000 01］. Moreover， such combination effectively reduced urinary albumin excretion rate ［standardized mean difference （SMD）=-2.61，95%CI （-3.17，-2.05），<italic>P</italic><0.000 01］，24-h proteinuria［SMD=-1.75，95%CI （-2.15，-1.35），<italic>P</italic><0.000 01］， serum creatinine（Scr）［mean difference （MD）=-14.57，95%CI （-17.94，-11.21），<italic>P</italic><0.000 01］， blood urea nitrogen（BUN）［MD=-1.05，95%CI （-1.29，-0.81），<italic>P</italic><0.000 01］， cystatin C （Cys-C） ［MD=-0.52，95%CI （-0.68，-0.36），<italic>P</italic><0.000 01］， fasting blood glucose（FBG）［MD=-0.59，95%CI （-0.93，-0.25），<italic>P</italic>=0.000 6］， hemoglobin A1c（HbA1c）［MD=-0.50，95%CI（-0.75，-0.24），<italic>P</italic>=0.000 1］， tumor necrosis factor-<italic>α</italic>（TNF）-<italic>α </italic>［SMD=-1.68，95%CI （-2.21，-1.15），<italic>P</italic><0.000 01］， C-reactive protein（CRP） ［SMD=-1.35，95%CI （-1.77，-0.93），<italic>P</italic><0.000 01］， and interleukin-6 （IL-6） ［SMD=-1.52，95%CI （-1.98，-1.07），<italic>P</italic><0.000 01］. There was no significant difference in the incidence of adverse events between the two groups ［RR=0.77，95%CI （0.49，1.21），<italic>P</italic>=0.25］. Conclusion:Fermented cordyceps powder combined with ACEI/ARB is more effective than ACEI/ARB in the treatment of DKD， which is worthy of clinical promotion and use. More multi-center RCTs with a large sample size are needed for verification.
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OBJECTIVE:To explore the effects of angiotensin converting enzyme inhibitors (ACEI)/angiotensin Ⅱ receptor blockers (ARB) on the prognosis in patients with advanced gastric cancer complicated with hypertension.METHODS:By retrospective study,clinical information of histologically confnrned Ⅲ-Ⅳ stage advanced gastric cancer patients with hypertension receiving 2 cycles of first-line chemotherapy plan containing fluorouracil at least were collected from Zhejiang Tumor Hospital during Jan.1st,2009-Dec.31th,2012.The data were summarized and analyzed.The patients receiving ACEI/ARB drugs were included in trial group,and the patients receiving other antihypertensive drugs were included in control group.Telephone follow-up was conducted in 2 groups.RESULTS:A total of 124 patients meeting the inclusion criteria were enrolled in this study.There was no statistical significance in age,gender,smoking history,ECOG score,family history of disease,family history of tumor,TNM staging,pathological type,tumor site or chemotherapy plan between trial group (23 cases) and control group (101 cases),except for history of alcohol intake (P＞0.05).Total response rate of first-line chemotherapy was 73.9％ in trial group,which was significantly higher than 41.6％ of control group,with statistical significance (P＜0.05).There was no statistical significance in 1-year or 3-year survival rate between 2 groups (P＞0.05).Median survival time of trial group was 669 d,which was significantly longer than 410 d of control group,with statistical significance (P＜0.05).Results of COX regression analysis showed that therapeutic efficacy of first-line chemotherapy influenced the survival of patients in different antihypertensive agent groups (P＜0.05).CONCLUSIONS:Compared with other antihypertensive drugs,ACEI/ARB agents significantly improve response rate of first-line chemotherapy in patients with advanced gastric cancer complicated with hypertension,significantly prolong median survival time,but have no significant effect on survival rate;at the same time,statistical comparison of definite drinking amount are absent.It needs to be further confirmed by multi-center,prospective and large-scale sample.
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OBJECTIVE:To study related factors of ACEI/ARB drugs in hypertension patients with coronary heart disease. METHODS:Six hundred hypertension patients with coronary heart disease were selected from a hospital during Jan. 2012-Jan. 2015,310 patients receiving ACEI/ARB drugs were included in observation group,and 290 patients not receiving these drugs were included in control group. General information and lab indexes of 2 groups were collected and analyzed. RESULTS:There were sta-tistical significances in ambulatory arterial stiffness indexes [(0.57±0.13),(0.40±0.11)],24 h average systolic blood pressure [ (146.42±11.24)mmHg,(132.31±9.85)mmHg],24 h average diastolic blood pressure [(78.14±9.21)mmHg,(82.79±8.33) mmHg],24 h ambulatory pulse pressure [(64.89±13.57)mmHg,(53.54±9.78)mmHg],drinking rate(58.71%,28.28%),moder-ate intensity rate(31.29%,65.17%),BMI[(33.28±2.07)kg/m2,(23.17±2.86)kg/m2],LVEF [(35.65±11.42)%,(48.01± 12.45)%],dyslipidemia rate(66.77%,30.34%),myocardial infarction rate(68.39%,39.66%),revascularization rate(69.68%, 33.10%)and duration of coronary heart disease between 2 groups(P<0.05). The duration of coronary heart disease,dyslipid-emia,myocardial infarction,revascularization were included in multivariate Logistic regression analysis,with statistical signifi-cance(P<0.05). CONCLUSIONS:The application of ACEI/ARB drugs in hypertension patients complicated with coronary heart disease is influenced by many factors;dyslipidemia,myocardial infarction and revascularization are positive independent influential factors of ACEI/ARB drug use in the treatment,but drug use rate will decline with the duration increase.
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OBJECTIVE: To discuss the efficacy and safety of agiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in patients with resistant hypertension and advanced chronic kidney disease. METHODS: The treatment of resistant hypertension in one patient with chronic kidney disease (stage 4) was analyzed. According to the latest guidelines and clinical trials, actual treatment situation was summarized and analyzed. RESULTS AND CONCLUSION: The efficacy and safety of ACEIs or ARBs in patients with advanced chronic kidney disease and hypertension remain uncertain, thus, cautions should be exercised. It's reasonable to use low dose ARBs for such a young patient, nevertheless, it is emphasised that pharmacists and physicians should regularly and constantly monitor the patients' serum levels of creatinine and potassium and late-onset renal failure resulted from angiotensin blockade in patients on ACEIs/ARBs in a collaborative way.
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MYH9-related disorder is an autosomal dominant disease caused by a mutation in the MYH9 gene, which encodes nonmuscle myosin heavy chain IIA (NMMHC-IIA). This disease is characterized by giant platelets, thrombocytopenia, granulocyte inclusion bodies, proteinuria, and high-pitch sensorineural deafness. Nephropathy has been observed in 30% of patients with MYH9-related disorder. The characteristic features are early onset proteinuria and rapidly progressing renal disorder. However, the prognosis of MYH9 nephropathy remains unclear. Herein, we describe a 36-year-old woman who presented with proteinuria and was diagnosed with MYH9 nephropathy via renal biopsy and gene analysis. Her proteinuria improved after administration of an angiotensin II receptor blocker, but was aggravated after changing to a calcium channel blocker.
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Adulto , Femenino , Humanos , Albuminuria , Biopsia , Canales de Calcio , Sordera , Granulocitos , Cuerpos de Inclusión , Cadenas Pesadas de Miosina , Pronóstico , Proteinuria , Receptores de Angiotensina , TrombocitopeniaRESUMEN
En enfermedad renal crónica etapa IV (ERC-IV) es alta la mortalidad y progresión a insuficiencia renal extrema (IRE). Objetivo: Valorar la calidad asistencial en una Clínica de Enfermedad Renal Crónica Avanzada (CERCA). Métodos: Estudio prospectivo de pacientes ERC- IV asistidos con un equipo multidisciplinario formal mediante estrategia de educación, asesoramiento nutricional, seguimiento clínico mensual, y tratamiento según metas de presión arterial (<130/80) reducción de proteinuria, uso de inhibidores de enzima de conversión (IECA) y/o Bloqueantes de receptores de angiotensina (BRA), tratamiento de dislipemia, y preparación para diálisis. Resultados: Se analizaron 150 pacientes, 50% masculino, 62,0 ± 14,4 años, Nefropatías vascular 20,4%, diabética 34,2% y 62,5% proteinúricos, con Índice de Charlson 3,67±1,57. En seguimiento de 1,4 años (IQ: 0,6-2,4) disminuyó la PA (147±35 a 132 ± 28mm), colesterol (210±55 a 179±50 mg/dL) y LDL (129±52 a 108±37 mg/dL) con aumento del uso de IECA/BRA (55,9 a 60,6 %) y estatinas (32,2 a 63,3%). La tasa de Mortalidad fue 5,3 e IRE 14,5/100 Pt- año. El Riesgo pérdida de FG mayor a la mediana o IRE aumentó con HTA, Pru >1 g/d y glomerulopatias y se redujo 90% con IEC/BRA (p<0.001). Al ingreso a diálisis la Hemoglobina ≥10g%, vacunación hepatitis B y acceso permanente fueron más frecuentes que en la población general. Conclusiones: En una Clínica multidisciplinaria con estrategia de control de riesgos se alcanzó mejor las metas de tratamiento, disminuyendo los factores de riesgo de progresión y mejorando el cuidado médico al ingreso a diálisis.
In stage IV chronic kidney disease (stage-IV CKD), mortality and progression to extreme renal failure (ERF) are high. Objective: Assessing the quality of health care in an Advanced Kidney Disease Clinic (AKDC). Methods: Prospective study of patients with stage-IV CKD treated by a multidisciplinary formal team through an educational strategy, nutritional advice, clinical nephrology follow-up, aimed at achieving blood pressure goals (<130/80), proteinuria reduction, use of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB), dyslipidemia treatment and preparation for dialysis. Results: 150 patients were analyzed, 50% were males, of 62.0 ± 14.4 years of age, 20.4% had vascular kidney diseases, 34.2% had diabetes and 62.5% had proteinuria with a Charlson index of 3.67 ± 1.57. In the 1.4-year follow-up (IQ: 0.6- 2.4), there were decreases in the BP (147±35 to 132±28 mm), cholesterol (210±55 to 179±50 mg/ dl) and LDL (129±52 to 108±37 mg/dl), and there was an increase in the use of ACEI/ARB (55.9to 60.6%) and statins (32.2 to 63.3%). The mortality rate was 5.3 and the ERF rate was 14.5/100 patient-years. The glomerular function loss risk, which was higher than the median or ERF, increased with HTN, Pru >1 g/d and glomerular diseases, and had a 90% decrease with ACEI/ARB(p<0.001). At dialysis entry, hemoglobin levels of≥10g%, hepatitis B vaccination and permanent access were more frequent than in the general population. Conclusions: Treatment goals were best achieved in a multidisciplinary clinic with a riskcontrol strategy, reducing progression risk factors and improving medical care upon dialysis entry.
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Humanos , Calidad de la Atención de Salud , Fallo Renal CrónicoRESUMEN
Renin-angiotensin system (RAS) is correlative with many diseases. Angio tensin II (AngII) plays an important role as the final effective approach for RAS. This article reviews the main approach to the action and biosynthesis of AngII: including AngII receptor blocker (ARB), chymase inhibitor and ACE2 which were disscoverd recently.
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Objectives To evaluate the effectiveness of ARB in antihypertensive therapy and judge whether it can also protect cardiovascular. Methods A randomized double-blinded placebo-controlled study was used to survey over ten thousand patients in ARB clinical practices. The primary endpoint was stroke, acute myocardial infarction, heart failure, deadly cardiovascular diseases, total mortal. The results were given comprehensive analysis and statistical processing. Results In LIFE study, ARB was more effective than ?-blockers and ARB had the role of protecting the cardiovascular besides lowering the blood pressure. But the VALUE study showed that ARB was not more effective than Besylate. Conclusion There is no obvious distinction between ARB and the other drugs in reducing the blood pressure.