[Therapeutic approaches to the Rational Use of trip-le combination therapy with a fixed combination of amlodipine, indapamide and perindopril arginine (TRIPLE COMBINATION) in patients with hypertension who do not control blood pressure on conventional treatment. (Description and main results of the TRIO program)].
[在常规治疗不控制血压的高血压患者中合理使用氨氯地平、吲达帕胺和培哚普利精氨酸固定组合 (三联组合) 的trip-le联合疗法的治疗方法。(TRIO程序的描述和主要结果)]。
- 作者列表："Mareev VY","Minina YV","Begrambekova YL","Levin AM
:Aim To study tactics of outpatient physicians in choosing the treatment when the previous double antihypertensive therapy (AHT) fails and to analyze the effectivity of an amlodipine/indapamide/perindopril arginine triple combination (TC).Material and methods The program included 1252 patients with arterial hypertension (AH); the TC group consisted of 992 (79.23 %) patients (38.3 % males; age, 61.6 [55.0; 67.9]); the control group included 260 (20.77 %) patients (37.7 % males; age, 60.6 [53.3; 67.4]). The main inclusion criteria were essential AH, age 18-79 years, insufficient response to previous AHT (clinical systolic blood pressure (SBP) >140-179 mm Hg). The study duration was three months. The following parameters were evaluated: dynamics of clinical and ambulatory BP (BP self-monitoring (BPSM); frequency of achieving the first goal of <140 / 90 mm Hg and the goal of <130 / 80 mm Hg); and changes in glomerular filtration rate (GFR) and quality of life (QoL). Responses to TC were analyzed in groups with different ranges of increased baseline SBP in patients with AH and diabetes mellitus (DM)/impaired glucose tolerance (IGT), overweight or obesity, and chronic kidney disease (CKD, reduced estimated GFR (eGFR <60 ml/min/1.73 m2). Safety was evaluated based on records of adverse events (AEs).Results The TC group had a more severe condition at baseline by clinical parameters and history and had higher baseline BP, which made difficult the intergroup comparison. Nevertheless at three months, the decrease in clinical SBP was more pronounced in the TC group (from 162.1 to 126.8 mm Hg, Δ=35.7 mm Hg) than in the control group (from 157.8 to 128.4 mm Hg, Δ=29.4 mm Hg). 87.8% of patients in the TC group and 81.9 % (р=0.012) in the control group achieved the first BP goal of <140 / 90 mm Hg; 34.3% and 28.2% of patients, respectively, achieved the BP goal of <130 / 80 mm Hg (р=0.055). The more effective SBP control in the TC group was associated with a pronounced BP decrease with higher BP values at baseline, which was also confirmed by an analysis in subgroups with SBP 140-160, 160-180, and >180 mm Hg. The TC treatment was associated with a pronounced antihypertensive effect with respect of BPSM values, improved QoL, and renal function. Significant decreases in BP and achievement of BP goals by a vast majority of patients receiving TC were also observed in subgroups with DM or IGT, overweight and/or obesity, and CKD. AEs were observed during the treatment only in 8 patients (0.64 %), which confirmed good tolerability and high safety of the therapy.Conclusion The study results demonstrated a therapeutic effect of the amlodipine/indapamide/perindopril arginine fixed-dose combination (Triplixam®). This effect was evident as control of clinical BP with any baseline BP level, including different ranges of increased SBP, in AH combined with DM, IGT, obesity, and CKD, which offers advantages over a subjective choice of AHT. TC improved BPSM values, QoL indexes, provided nephroprotection, and was well tolerated.
目的研究门诊医师在既往双联降压治疗 (AHT) 失败时选择治疗方案的策略，分析氨氯地平/吲达帕胺/培哚普利精氨酸三联疗法 (TC) 的疗效。材料和方法该项目包括1252名动脉高血压 (AH) 患者; TC组包括992名 (79.23%) 患者(男性38.3 %; 年龄，61.6 [55.0; 67.9]); 对照组包括260 (20.77 %) 例患者 (男性37.7 %; 年龄，60.6 [53.3; 67.4])。主要纳入标准为 “必需AH”，年龄18-79岁，对既往AHT反应不足 (临床收缩压 (SBP) >140-179毫米mmhg)。研究持续时间为3个月。评估了以下参数: 临床和动态血压动力学 (BP自我监测 (BPSM)); 实现 <140 Hg/90 Hg mmhg的第一目标和 <130 /80 Hg mmhg的目标的频率; 和肾小球滤过率 (GFR) 的变化和生活质量 (QoL)。在患有AH和糖尿病 (DM)/葡萄糖耐量受损 (IGT)，超重或肥胖和慢性肾脏疾病 (CKD，估计GFR降低 (eGFR <60 ml/min/1.73平方米) 的患者中，在基线SBP升高的不同范围的组中分析对TC的反应。根据不良事件 (ae) 记录评估安全性。结果根据临床参数和病史，TC组在基线时病情更严重，基线BP更高，这使得组间比较困难。尽管如此，在三个月时，临床SBP的下降在TC组 (从162.1至126.8毫米Hg，Δ = 35.7mm Hg) 比在对照组 (从157.8至128.4mm Hg，Δ = 29.4mm Hg) 中更明显。TC组87.8% 的患者和对照组81.9 (р = 0.012) 的患者达到第一个BP目标 <140/90 mmhg; 分别为34.3% 和28.2% 的患者，实现了 <130 Hg/80 80 Hg mm Hg (р = 0.055) 的BP目标。TC组中更有效的SBP控制与基线时较高的BP值显著降低相关，这也通过SBP 140-160，160-180和> 180毫米Hg亚组的分析得到证实。在BPSM值、改善的QoL和肾功能方面，TC治疗与显著的抗高血压作用相关。在患有DM或IGT、超重和/或肥胖和CKD的亚组中也观察到绝大多数接受TC的患者的BP显著降低和BP目标的实现。只有8名患者 (0.64) 在治疗期间观察到ae，这证实了该疗法的良好耐受性和高安全性。结论研究结果证明了氨氯地平/吲达帕胺/培哚普利精氨酸固定剂量组合 (Triplixam) 的治疗效果®)。在AH合并DM、IGT、肥胖和CKD的情况下，在任何基线BP水平 (包括不同范围的SBP增加) 下控制临床BP时，这种效果是明显的，这比主观选择AHT提供了优势。TC改善了BPSM值、QoL指数，提供了肾保护，并且耐受性良好。
METHODS::Aim: We explored the role of histone modification in the association of depression-hypertension by comparing norepinephrine transporter (NET) gene levels in different depression-hypertensive patients. Then, we analyzed the expression of NET correlation with inflammatory cytokines to provide a new direction for detecting the association mechanism between depression and hypertension.Methods: NE expression levels in serum of diverse groups were detected by enzyme-linked immunosorbent assay. Then histone acetyltransferase (HAT), histone deacetylase (HDAC), H3K27ac, NET, TNF-α, and interleukin-6 (IL-6) were detected by western blot in nine female subjects in different depression and hypertension groups, and Chromatin immunoprecipitation-polymerase chain reaction (Chip-PCR) were used to confirm the degree of acetylation affecting on the transcription level of NET gene. Meanwhile, correlation between NET with TNF/IL-6 was analyzed by SPSS19.0 software program. Finally, Quantitative real-time polymerase chain reaction (qPCR) and western blot were used to detect TNF-α and IL-6 expression levels after NET overexpression or interference treatment in human umbilical vein endothelial cells and Neuro-2a cells.Results: The expression of HAT and H3K27ac had lower levels in D-H and nonD-H group than nonD-nonH group. The results showed that higher acetylation could promote expression of NET genes. Meanwhile, the expression of NET had a significant negative correlation with IL-6 (R = -0.933, p < 0.01) and tumor necrosis factor (TNF) (R = -0.817, p < 0.01) in subjects. In addition, the results confirmed that TNF-α and IL-6 mRNA and protein partial expressions could be inhibited by NET in both HUVECs and Neuronal cells (p < 0.01).Conclusion: In conclusion, differential expression of NET gene might function as an important factor in interaction between depression and hypertension by partially targeting TNF-α and IL-6.
METHODS::The Middle East and North Africa (MENA) region has a high burden of morbidity and mortality due to premature (≤55 years in men; ≤65 years in women) myocardial infarction (MI) and acute coronary syndrome (ACS). Despite this, the prevalence of risk factors in patients presenting with premature MI or ACS is incompletely described. We compared lifestyle, clinical risk factors, and biomarkers associated with premature MI/ACS in the MENA region with selected non-MENA high-income countries. We identified English-language, peer-reviewed publications through PubMed (up to March 2018). We used the World Bank classification system to categorize countries. Patients with premature MI/ACS in the MENA region had a higher prevalence of smoking than older patients with MI/ACS but a lower prevalence of diabetes, hypertension, and dyslipidemia. Men with premature MI/ACS had a higher prevalence of smoking than women but a lower prevalence of diabetes and hypertension. The MENA region had sparse data on lifestyle, diet, psychological stress, and physical activity. To address these knowledge gaps, we initiated the ongoing Gulf Population Risks and Epidemiology of Vascular Events and Treatment (Gulf PREVENT) case-control study to improve primary and secondary prevention of premature MI in the United Arab Emirates, a high-income country in the MENA region.
METHODS:OBJECTIVE:The aim of our study was to determine if a genetic background of high blood pressure is a survival factor in preterm infants. DESIGN:Prospective cohort study. SETTING:Patients were enrolled in 53 neonatal intensive care units. PATIENTS:Preterm infants with a birth weight below 1500 g. EXPOSURES:Genetic score blood pressure estimates were calculated based on adult data. We compared infants with high genetic blood pressure estimates (>75th percentile of the genetic score) to infants with low genetic blood pressure estimates (<25th percentile of the genetic score). MAIN OUTCOME MEASURES:Lowest blood pressure on the first day of life and mortality. RESULTS:5580 preterm infants with a mean gestational age of 28.1±2.2 weeks and a mean birth weight of 1022±299 g were genotyped and analysed. Infants with low genetic blood pressure estimates had significantly lower blood pressure if compared with infants with high genetic blood pressure estimates (27.3±6.2vs 27.9±6.4, p=0.009, t-test). Other risk factors for low blood pressure included low gestational age (-1.26 mm Hg/week) and mechanical ventilation (-2.24 mm Hg, p<0.001 for both variables, linear regression analysis). Mortality was significantly reduced in infants with high genetic blood pressure estimates (28-day mortality: 21/1395, 1.5% vs 44/1395, 3.2%, p=0.005, Fisher's exact test). This survival advantage was independent of treatment with catecholamines. CONCLUSIONS:Our study provides first evidence that a genetic background of high blood pressure may be beneficial with regard to survival of preterm infants.