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unimib.it
The ultimate goal when treating high blood pressure is to reduce the incidence of end-organ damage and prevent cardiovascular disease, and thus reduce the incidence of premature death. Cuff blood pressure measurements have some prognostic value and have traditionally been used to predict the risk of end-organ damage. Such measurements, however, do not reflect accurately the 24-h mean blood pressure and hourly variations. For any value of cuff blood pressure, a lower 24-h mean blood pressure was associated with a lower prevalence and severity of end-organ damage. In the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, data from 24-h ambulatory blood pressure monitoring (ABPM) were more strongly associated with prognosis than other blood pressure data. Longitudinal evidence of the clinical relevance of 24-h ABPM data in predicting cardiovascular risk is less extensive. However, results from the Study on Ambulatory Monitoring of Pressure and Lisinopril Evaluation (SAMPLE) trial show the superiority of mean 24-h, daytime and night-time blood pressures over clinic readings in predicting the regression of left ventricular mass index in treated hypertensive patients. Furthermore, a direct, positive relationship has been established between 24-h blood pressure variability and the severity and rate of progression of end-organ damage. In addition, ABPM data demonstrate that hypertensive patients who do not exhibit a nocturnal reduction in blood pressure have a higher incidence of end-organ damage. Future directions for research and treatment of hypertension will need to consider the circadian cycle of blood pressure, the effect of treatment on blood pressure variability, and the magnitude of blood pressure changes in daily life.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14694911&dopt=Abstract [PubMed - in process]
kp.org
STUDY OBJECTIVE: As the results of the Heart Outcomes Prevention Evaluation trial suggested that patients with both coronary artery disease (CAD) and diabetes mellitus would benefit from angiotensin-converting enzyme (ACE) inhibitor therapy, our objective was to increase the percentage of patients with both of these conditions receiving the goal dosage (20 mg/day) or highest tolerated dosage of the ACE inhibitor lisinopril through intervention of a clinical pharmacy service. STUDY DESIGN: Prospective study with historic comparison (control group). SETTING: Clinical Pharmacy Cardiac Risk Service. PATIENTS: Hospitalized patients with CAD and type 2 diabetes mellitus. MEASUREMENTS AND MAIN RESULTS: At hospital discharge, lisinopril 5 mg/day was started in eligible patients; the drug was titrated to a goal dosage of 20 mg/day or the highest tolerated dosage. Potassium level, serum creatinine level, and blood pressure were monitored at baseline, at each dosage titration, and 2 weeks after the goal or highest tolerated dosage was reached. The group receiving usual care (control group) consisted of 95 patients; the treatment group had 101 patients. At baseline, 19 patients (20%) in the control group were receiving the goal dosage of lisinopril, 34 (36%) were taking a suboptimal dosage, 16 (17%) were excluded from treatment, and 26 (27%) were eligible but were not receiving lisinopril therapy. After 9 months, ACE inhibitor dosages had changed minimally in the control group. In the treatment group, at baseline, 37 patients (36%) were at their goal dosage and therefore titration was not necessary; 15 (15%) were receiving a suboptimal dosage, 35 (35%) were excluded from treatment, and 14 (14%) were eligible but not receiving therapy. After the titration period, 55 (54%) treatment group patients were at the goal dosage, 11 (11%) were taking a suboptimal dosage, and 35 (35%) were not candidates for ACE inhibitor therapy. The most common reasons for exclusion were renal insufficiency, cough, and baseline hypotension. Changes in potassium level, serum creatinine level, and blood pressure were not significant during the study. CONCLUSION: The clinical pharmacy service more than doubled the number of patients with CAD and diabetes who achieved the goal dosage of an ACE inhibitor, a drug class that has been shown to decrease morbidity and mortality in this patient population.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14695037&dopt=Abstract [PubMed - in process]
J Cardiovasc Pharmacol. 2004 Feb;43(2):294-9.
Cardioprotective effect of zofenopril in perfused rat heart subjected to ischemia and reperfusion.
Frascarelli S, Ghelardoni S, Ronca-Testoni S, Zucchi R.
Dipartimento di Scienze dell'Uomo e dell'Ambiente, University of Pisa, Pisa, Italy.
We investigated the effect of different ACE inhibitors on tissue injury in isolated rat hearts subjected to 30 minutes of ischemia followed by 120 minutes of reperfusion. Zofenoprilat (1-100 microM), but not enalaprilat or lisinopril, significantly reduced infarct size, as estimated on the basis of triphenyltetrazolium chloride staining. The protection was not reproduced by the angiotensin II receptor antagonist irbesartan, and it was partly abolished by the bradykinin receptor antagonist HOE 140. Zofenoprilat molecule contains a sulfhydryl group, and its administration, as compared with enalaprilat or lisinopril administration, was associated with better preservation of protein thiols at the end of ischemia. We conclude that zofenopril has a specific cardioprotective effect, which might be related either to interference with bradykinin metabolism or to preservation of protein sulfhydryl groups.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14716220&dopt=Abstract [PubMed - in process]
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