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2022 DEC 17 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on Peptide Proteins - Peptide Hormones is now available. [...]

2022 OCT 22 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Researchers detail new data in COVID-19. According to news originating from Shiraz, [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2009.06.031 Byline: Marco Fornasini (a), Jorge Yarzebski (b), David Chiriboga (b), Darleen Lessard (b), Frederick A. Spencer (b)(c), Philip Aurigemma (b), Joel M. Gore (b), Robert J. Goldberg (b) Keywords: Acute myocardial infarction; Changing trends; Management practices; Population-based investigation Abstract: Guidelines for the management of patients with acute myocardial infarction recommend the routine use of 4 effective cardiac medications: angiotensin-converting enzyme inhibitors, aspirin, [beta]-blockers, and lipid-lowering agents. Limited data are available, however, about the contemporary and changing use of these therapies, particularly from a population-based perspective. The study describes differences in the use of these medications during hospitalization for acute myocardial infarction according to age, gender, and period of hospitalization. Author Affiliation: (a) College of Health Sciences, Universidad San Francisco de Quito, Quito, Ecuador (b) Department of Medicine, University of Massachusetts Medical School, Worcester (c) Department of Medicine, McMaster University, Hamilton, Ontario Article Note: (footnote) Funding: National Institutes of Health (RO1 HL35434)., Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript., Authorship: All authors had access to the data and played a role in writing this manuscript.

Although large randomized clinical trials remain the foundation for informing evidence-based prescribing, vast data sources can provide insight into complex questions that arise in clinical decision-making. Using tens of thousands [...]

Abstract Background: Existing clinical trial data do not address whether all angiotensin-converting-enzyme (ACE) inhibitors are similarly beneficial in improving survival and reducing the rate of readmission among patients with congestive [...]

Cardiovascular disease (CVD) is the major cause of death in developed countries and is rapidly becoming the rnajor cause of death in the developing world. The increasing rates of obesity and type 2 diabetes, however, may slow the current favorable trends for deaths attributable to CVD in many developed countries. To improve control of risk factors for CVD, Wald and Law proposed a 'polypill,' containing a statin, a diuretic, a/3-blocker, ah angiotensin-converting enzyrne inhibitor, aspirin, and folic acid. This combination pharmacotherapy (CP) could be made widely available without treating specific risk factors or individuals. A workshop sponsored by the Centers for Disease Control and Prevention reviewed the concept of CP for both prirnary and secondary prevention. Combination pharmacotherapy may prove to be efficacious but may also have side effects and poor adherence, which may be greater than or less than that of other preventive approaches. Randomized trials are needed to study these issues, although the design for such trials is uncertain. The ability of CP to prevent CVD in a cost-effective manner must be demonstrated. Minority groups and people with Iow socioeconomic status in the United States have an increased risk for CVD, and the effectiveness of such pharmacotherapy must be considered for these populations. Combination pharmacotherapy may prove especially effective in the developing world, where studies of CP may precede those done in wealthier countries. Combination pharmacotherapy may have tremendous potential, but additional study and detailed evaluation are necessary.

A glomerular permeability defect occurs early in the course of type 1 diabetes and precedes the onset of microalbuminuria and renal morphological changes. Recently, ACE inhibitors have been shown to prevent loss of glomerular membrane permselective function, but the mechanism of this nephroprotective effect is still being debated. The objective of the present study was to evaluate the effects of hypotensive and subhypotensive dosages of the ACE inhibitor quinapril ex vivo and of its active metabolite quinaprilat in vitro on the glomerular albumin permeability ([P.sub.alb]) defect in the early phases of experimental diabetes. For the ex vivo study, six groups of male Wistar rats were evaluated for 4 weeks. One group served as a nondiabetic control (C); the other five groups were rendered diabetic and included untreated diabetic rats (D) and diabetic rats receiving quinapril at the dosages of 5 (DQ1), 2.5 (DQ2), 1.25 (DQ3), and 0.625 (DQ4) mg x [kg.sup.-1] x [day.sup.-1]. Dosage-dependent effects of quinapril on systolic blood pressure and the glomerular filtration rate were observed. In contrast, control of [P.sub.alb] in isolated glomeruli exposed to oncotic gradients, proteinuria, and glomerular and tubular hypertrophy was obtained with subhypotensive dosages (DQ3 and DQ4 groups) of the ACE inhibitor. In the in vitro study, quinaprilat reduced [P.sub.alb] significantly in concentration ranges from [10.sup.-6] to [10.sup.-14] mol/l compared with results in control glomeruli. The effect on [P.sub.alb] may have occurred by mechanisms different from kidney ACE inhibitor. These study results indicated that ACE inhibitor treatment prevents the early onset of the [P.sub.alb] defect in experimental diabetes. This effect seemed to occur independently of systemic or glomerular hemodynamic changes and, at least partially, from kidney ACE inhibition., Microalbuminuria is early marker of diabetic nephropathy (1), and its presence is indicative of an increased risk not only of overt nephropathy (2) but also of cardiovascular disease and death [...]

The nature of cardiac failure, a syndrome, not a specific disease, and its treatment are discussed. Heart failure incidence is high in Australia and likely to go up as the population ages. ACE inhibitors, nevertheless, are generally underused or used in doses that are insufficient, although they are the mainstay of therapy.

In patients at risk for chronic renal failure, early clinical interventions have been shown to prevent or delay progression of the disease. A low-protein diet is recommended when the serum creatinine is between 1.5 and 2.5 mg/dl. Benefits from protein restriction can only be achieved if energy intake is greater than 35 kcal/kg/d. To preserve skeletal muscle, correct metabolic acidosis with oral sodium bicarbonate supplementation. For hypertension control and renal protection, start ACE inhibitors when serum creatinine is less than 2 mg/dl. Correct anemia with erythropoietin to improve or maintain quality of life when the hematocrit falls below 30%. For the diabetic, ACE inhibitors and glycemic control have been shown to slow the rate of renal failure., Prior to 1960, end-stage renal disease (ESRD) was uniformly fatal. Since then, patients have been able to survive, thanks to the development of the Quinton-Scribner external shunt and renal dialysis. [...]

Background: Two new classes of antihypertensive agents were introduced in the 1980s, but their effectiveness in preventing heart disease and stroke has not been demonstrated. Lack of evidence of their efficacy might reasonably be expected to discourage their widespread use in management of hypertension.

Purpose: Secretion of brain natriuretic peptide (BNP), a cardiac hormone, is accelerated via hypertrophied ventricles in experimental hypertension. The present study examined whether regression of left ventricular (LV) hypertrophy by long-term treatment with an angiotensin-converting enzyme inhibitor (ACEI) affects plasma BNP concentration in patients with essential hypertension. Patients and Methods: Thirty-one hypertensive patients with LV hypertrophy were treated with ACEI (16 with enalapril; 15 with lisinopril) for 1 year. Serial changes were recorded in LV mass index, LV systolic function, and plasma concentrations of BNP and atrial natriuretic peptide (ANP). Results: ACEI therapy significantly reduced LV mass index at 6 months, and more so at 1 year. Septal and posterior wall thicknesses were also reduced. Plasma BNP and ANP were markedly elevated at study entry, but only BNP levels correlated with LV mass index. Both peptide levels declined after 6 months, and this decline was enhanced at 1 year. There was a close relation between BNP decline and LV mass index reduction overall and with enalapril and lisinopril separately. Changes in ANP and in LV mass index were not related. Conclusion: Long-term ACEI therapy can reduce elevated plasma BNP. in this study, changes in BNP reflected the magnitude of regression of LVH. Plasma BNP may be a useful marker for LVH during antihypertensive therapy in patients with essential hypertension and LVH.

Too busy to read all the latest journals? Let Dr Louise Newson bring you up to date with the research. Who attends diabetes screening? Diabet Med 2010; 27: 995-1003 There [...]

A retrospective study investigates the effect of evidence-based medication use on long-term survival in patients hospitalized for heart failure (HF) in Western Australia. Results indicate that evidence-based medication such as angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) and beta-blockers prescribed on discharge after the first hospitalization for HF improve long-term survival of patients.

Dr Raj Thakkar outlines the risks and benefits of ACE inhibitor therapy in renal disease. Renal artery stenosis, defined as narrowing of the renal artery or arteries, can be uni- [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2008.05.017 Byline: L. Michael Prisant Keywords: Angiotensin-converting enzyme inhibitor; Angiotensin receptor blocker; Heart failure; High cardiovascular risk; Hypertension; Left ventricular dysfunction Abstract: Inhibition of renin-angiotensin system (RAS) activity using angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ARBs) is beneficial in patient populations with left ventricular dysfunction or systolic heart failure (HF) and other forms of heart disease. In high-risk patients with coronary heart disease (CHD), treatment with these agents reduces the mortality rate and improves secondary outcomes. Individuals with stable CHD who are at lower risk benefit less from treatment. RAS inhibition also provides some clinical benefit to patients with diastolic HF and preserved left ventricular function. Left ventricular hypertrophy (LVH) is a strong predictor of cardiovascular events and all-cause mortality in patients with hypertension. Treatment with an ARB reduces the risk for adverse cardiovascular outcomes in patients with hypertension and LVH. The benefits correlate with regression of LVH, and the effect is independent of the degree of blood pressure lowering. Finally, studies indicate that a history of hypertension in patients who have not had a myocardial infarction (MI) increases the risk for HF after MI; the risk is decreased in patients with hypertension who receive treatment with a RAS inhibitor. Author Affiliation: Hypertension and Pharmacology Unit, Medical College of Georgia, Augusta, Georgia, USA Article Note: (footnote) Statement of author disclosure: Please see the Author Disclosures section at the end of this article.

The draft NICE guideline on secondary prevention in patients following an MI has signalled a further move away from beta-blockers as the mainstay of cardiovascular care. The draft guideline, released [...]

GPs have rejected calls for all patients with atherosclerosis to be considered for ACE inhibitor therapy. An international team of experts last week stated that all patients with symptomatic vascular [...]

Chronic kidney disease (CKD) patients with proteinuria should be treated with ACE inhibitors or angiotensin receptor blockers (ARBs) irrespective of BP, according to draft guidelines from the Scottish Intercollegiate Guidelines [...]

Chronic kidney disease (CKD) patients with proteinuria should be treated with ACE inhibitors or angiotensin receptor blockers (ARBs) irrespective of BP, according to draft guidelines. The Scottish Intercollegiate Guidelines Network [...]

NICE has released its final revised guidance on hypertension which sees ACE inhibitors recommended as first line treatment for people under 55 years, calcium antagonists and diuretics as first line [...]

Medicines Beta-blockers will be replaced Beta-blockers should no longer be used for treating hypertension, says updated guidance from Nice. Instead, calcium channel blockers, thiazide diuretics and ACE inhibitors should be [...]

ACE inhibitor treatment reduces the risk of developing gastro-intestinal cancers, according to research presented at the DDW conference last week. Information on drug use and cancer was collected from 483,733 [...]

Beta-blockers have been relegated to the position of fourth-choice antihypertensive under draft guidance produced jointly by NICE and the British Hypertension Society (BHS). The guidance on management of hypertension in [...]

European Society of Cardiology - Beta-blockers, ace inhibitors in over-65s and CVD in women. GPs can start heart failure patients on either beta-blockers or ACE inhibitors, as long as they [...]