The Effect of Combined Angiotensin-Converting Enzyme Inhibition and Calcium Antagonism on Allograft Coronary Vasculopathy Validated by Intravascular Ultrasound
Hypertension is a potential risk factor for allograft coronary vasculopathy. We evaluated the efficacy of angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists, and their combined use, on the development of coronary vasculopathy in hypertensive heart transplant recipients. Eighty-tw...
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Veröffentlicht in: | The Journal of heart and lung transplantation 2005-08, Vol.24 (8), p.1033-1038 |
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container_title | The Journal of heart and lung transplantation |
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creator | Erinc, Kursad Yamani, Mohamad H. Starling, Randall C. Crowe, Tim Hobbs, Robert Bott-Silverman, Corinne Rincon, Gustavo Young, James B. Feng, Jingyuan Cook, Daniel J. Smedira, Nicholas Tuzcu, E. Murat |
description | Hypertension is a potential risk factor for allograft coronary vasculopathy. We evaluated the efficacy of angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists, and their combined use, on the development of coronary vasculopathy in hypertensive heart transplant recipients.
Eighty-two heart transplant recipients underwent serial intravascular ultrasound (IVUS) analysis at baseline (within 1 month) and at 1 year after transplantation and were evaluated for the development of coronary vasculopathy. Patients were divided into 4 groups. Nineteen normotensive recipients received no treatment, control (Group A). Hypertensive patients were treated with either ACE inhibitors (Group B,
n = 37), calcium antagonists (Group C,
n = 16), or both (Group D,
n = 10).
We found a significant reduction in IVUS indices of coronary vasculopathy in heart transplant recipients who used a combination of an ACE inhibitor and a calcium antagonist compared with recipients who used either drug alone (
p < 0.05). This synergistic efficacy was independent of the baseline indices evaluated in a multivariate regression analysis model and was noted despite comparable mean arterial pressure among the 3 hypertensive groups at 1 year, thus suggesting the presence of a synergistic anti-proliferative effect beyond the anti-hypertensive efficacy.
The combined use of an ACE inhibitor and a calcium antagonist is more effective than the individual use of either drug alone on the development of coronary vasculopathy in cardiac transplant recipients. Large randomized clinical trials are warranted to evaluate such a synergistic efficacy. |
doi_str_mv | 10.1016/j.healun.2004.06.005 |
format | Article |
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Eighty-two heart transplant recipients underwent serial intravascular ultrasound (IVUS) analysis at baseline (within 1 month) and at 1 year after transplantation and were evaluated for the development of coronary vasculopathy. Patients were divided into 4 groups. Nineteen normotensive recipients received no treatment, control (Group A). Hypertensive patients were treated with either ACE inhibitors (Group B,
n = 37), calcium antagonists (Group C,
n = 16), or both (Group D,
n = 10).
We found a significant reduction in IVUS indices of coronary vasculopathy in heart transplant recipients who used a combination of an ACE inhibitor and a calcium antagonist compared with recipients who used either drug alone (
p < 0.05). This synergistic efficacy was independent of the baseline indices evaluated in a multivariate regression analysis model and was noted despite comparable mean arterial pressure among the 3 hypertensive groups at 1 year, thus suggesting the presence of a synergistic anti-proliferative effect beyond the anti-hypertensive efficacy.
The combined use of an ACE inhibitor and a calcium antagonist is more effective than the individual use of either drug alone on the development of coronary vasculopathy in cardiac transplant recipients. Large randomized clinical trials are warranted to evaluate such a synergistic efficacy.</description><identifier>ISSN: 1053-2498</identifier><identifier>EISSN: 1557-3117</identifier><identifier>DOI: 10.1016/j.healun.2004.06.005</identifier><identifier>PMID: 16102438</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Angiotensin-Converting Enzyme Inhibitors - administration & dosage ; Biological and medical sciences ; Calcium Channel Blockers - administration & dosage ; Cardiology. Vascular system ; Case-Control Studies ; Coronary Disease - diagnostic imaging ; Coronary Disease - drug therapy ; Coronary Disease - physiopathology ; Coronary heart disease ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Graft Rejection ; Graft Survival ; Heart ; Heart Transplantation - adverse effects ; Heart Transplantation - methods ; Humans ; Hypertension - complications ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Postoperative Complications - diagnosis ; Postoperative Complications - drug therapy ; Probability ; Reference Values ; Severity of Illness Index ; Statistics, Nonparametric ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Survival Rate ; Treatment Outcome ; Ultrasonography, Interventional</subject><ispartof>The Journal of heart and lung transplantation, 2005-08, Vol.24 (8), p.1033-1038</ispartof><rights>2005 International Society for Heart and Lung Transplantation</rights><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c456t-4b5e0b2f486128ee84686ed5ae5d65a94571332a7e8acfd63e24cccb0fa0956c3</citedby><cites>FETCH-LOGICAL-c456t-4b5e0b2f486128ee84686ed5ae5d65a94571332a7e8acfd63e24cccb0fa0956c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1053249804003420$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17063514$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16102438$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Erinc, Kursad</creatorcontrib><creatorcontrib>Yamani, Mohamad H.</creatorcontrib><creatorcontrib>Starling, Randall C.</creatorcontrib><creatorcontrib>Crowe, Tim</creatorcontrib><creatorcontrib>Hobbs, Robert</creatorcontrib><creatorcontrib>Bott-Silverman, Corinne</creatorcontrib><creatorcontrib>Rincon, Gustavo</creatorcontrib><creatorcontrib>Young, James B.</creatorcontrib><creatorcontrib>Feng, Jingyuan</creatorcontrib><creatorcontrib>Cook, Daniel J.</creatorcontrib><creatorcontrib>Smedira, Nicholas</creatorcontrib><creatorcontrib>Tuzcu, E. Murat</creatorcontrib><title>The Effect of Combined Angiotensin-Converting Enzyme Inhibition and Calcium Antagonism on Allograft Coronary Vasculopathy Validated by Intravascular Ultrasound</title><title>The Journal of heart and lung transplantation</title><addtitle>J Heart Lung Transplant</addtitle><description>Hypertension is a potential risk factor for allograft coronary vasculopathy. We evaluated the efficacy of angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists, and their combined use, on the development of coronary vasculopathy in hypertensive heart transplant recipients.
Eighty-two heart transplant recipients underwent serial intravascular ultrasound (IVUS) analysis at baseline (within 1 month) and at 1 year after transplantation and were evaluated for the development of coronary vasculopathy. Patients were divided into 4 groups. Nineteen normotensive recipients received no treatment, control (Group A). Hypertensive patients were treated with either ACE inhibitors (Group B,
n = 37), calcium antagonists (Group C,
n = 16), or both (Group D,
n = 10).
We found a significant reduction in IVUS indices of coronary vasculopathy in heart transplant recipients who used a combination of an ACE inhibitor and a calcium antagonist compared with recipients who used either drug alone (
p < 0.05). This synergistic efficacy was independent of the baseline indices evaluated in a multivariate regression analysis model and was noted despite comparable mean arterial pressure among the 3 hypertensive groups at 1 year, thus suggesting the presence of a synergistic anti-proliferative effect beyond the anti-hypertensive efficacy.
The combined use of an ACE inhibitor and a calcium antagonist is more effective than the individual use of either drug alone on the development of coronary vasculopathy in cardiac transplant recipients. Large randomized clinical trials are warranted to evaluate such a synergistic efficacy.</description><subject>Aged</subject><subject>Angiotensin-Converting Enzyme Inhibitors - administration & dosage</subject><subject>Biological and medical sciences</subject><subject>Calcium Channel Blockers - administration & dosage</subject><subject>Cardiology. Vascular system</subject><subject>Case-Control Studies</subject><subject>Coronary Disease - diagnostic imaging</subject><subject>Coronary Disease - drug therapy</subject><subject>Coronary Disease - physiopathology</subject><subject>Coronary heart disease</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug Administration Schedule</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Graft Rejection</subject><subject>Graft Survival</subject><subject>Heart</subject><subject>Heart Transplantation - adverse effects</subject><subject>Heart Transplantation - methods</subject><subject>Humans</subject><subject>Hypertension - complications</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - drug therapy</subject><subject>Probability</subject><subject>Reference Values</subject><subject>Severity of Illness Index</subject><subject>Statistics, Nonparametric</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><subject>Ultrasonography, Interventional</subject><issn>1053-2498</issn><issn>1557-3117</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc2O0zAUhSMEYoaBN0DIG9gl-D_pBqmKCow0EpsZtpbj3LSuHLvYTqXyMrwqLq00O1b21f3OufY9VfWe4IZgIj_vmx1ot_iGYswbLBuMxYvqlgjR1oyQ9mW5Y8FqylfdTfUmpT3GmDJBX1c3RBJMOetuqz-PO0CbaQKTUZhQH-bBehjR2m9tyOCT9XUf_BFitn6LNv73aQZ073d2sNkGj7QfUa-dsctcRFlvg7dpRqWzdi5so55ycY3B63hCP3UyiwsHnXfnwtlR5zJsOBXHHPXxX1tH9ORKlcLix7fVq0m7BO-u51319HXz2H-vH358u-_XD7XhQuaaDwLwQCfeSUI7gI7LTsIoNIhRCr3ioiWMUd1Cp800SgaUG2MGPGm8EtKwu-rTxfcQw68FUlazTQac0x7CkpTseNdKRgvIL6CJIaUIkzpEO5fPKYLVORi1V5dg1DkYhaUqwRTZh6v_MswwPouuSRTg4xUoS9Buitobm565FksmCC_clwsHZRtHC1ElY8EbGG0sIaox2P-_5C-V3bGz</recordid><startdate>20050801</startdate><enddate>20050801</enddate><creator>Erinc, Kursad</creator><creator>Yamani, Mohamad H.</creator><creator>Starling, Randall C.</creator><creator>Crowe, Tim</creator><creator>Hobbs, Robert</creator><creator>Bott-Silverman, Corinne</creator><creator>Rincon, Gustavo</creator><creator>Young, James B.</creator><creator>Feng, Jingyuan</creator><creator>Cook, Daniel J.</creator><creator>Smedira, Nicholas</creator><creator>Tuzcu, E. 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Murat</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c456t-4b5e0b2f486128ee84686ed5ae5d65a94571332a7e8acfd63e24cccb0fa0956c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Aged</topic><topic>Angiotensin-Converting Enzyme Inhibitors - administration & dosage</topic><topic>Biological and medical sciences</topic><topic>Calcium Channel Blockers - administration & dosage</topic><topic>Cardiology. Vascular system</topic><topic>Case-Control Studies</topic><topic>Coronary Disease - diagnostic imaging</topic><topic>Coronary Disease - drug therapy</topic><topic>Coronary Disease - physiopathology</topic><topic>Coronary heart disease</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug Administration Schedule</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Graft Rejection</topic><topic>Graft Survival</topic><topic>Heart</topic><topic>Heart Transplantation - adverse effects</topic><topic>Heart Transplantation - methods</topic><topic>Humans</topic><topic>Hypertension - complications</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - drug therapy</topic><topic>Probability</topic><topic>Reference Values</topic><topic>Severity of Illness Index</topic><topic>Statistics, Nonparametric</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Survival Rate</topic><topic>Treatment Outcome</topic><topic>Ultrasonography, Interventional</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Erinc, Kursad</creatorcontrib><creatorcontrib>Yamani, Mohamad H.</creatorcontrib><creatorcontrib>Starling, Randall C.</creatorcontrib><creatorcontrib>Crowe, Tim</creatorcontrib><creatorcontrib>Hobbs, Robert</creatorcontrib><creatorcontrib>Bott-Silverman, Corinne</creatorcontrib><creatorcontrib>Rincon, Gustavo</creatorcontrib><creatorcontrib>Young, James B.</creatorcontrib><creatorcontrib>Feng, Jingyuan</creatorcontrib><creatorcontrib>Cook, Daniel J.</creatorcontrib><creatorcontrib>Smedira, Nicholas</creatorcontrib><creatorcontrib>Tuzcu, E. 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Murat</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Effect of Combined Angiotensin-Converting Enzyme Inhibition and Calcium Antagonism on Allograft Coronary Vasculopathy Validated by Intravascular Ultrasound</atitle><jtitle>The Journal of heart and lung transplantation</jtitle><addtitle>J Heart Lung Transplant</addtitle><date>2005-08-01</date><risdate>2005</risdate><volume>24</volume><issue>8</issue><spage>1033</spage><epage>1038</epage><pages>1033-1038</pages><issn>1053-2498</issn><eissn>1557-3117</eissn><abstract>Hypertension is a potential risk factor for allograft coronary vasculopathy. We evaluated the efficacy of angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists, and their combined use, on the development of coronary vasculopathy in hypertensive heart transplant recipients.
Eighty-two heart transplant recipients underwent serial intravascular ultrasound (IVUS) analysis at baseline (within 1 month) and at 1 year after transplantation and were evaluated for the development of coronary vasculopathy. Patients were divided into 4 groups. Nineteen normotensive recipients received no treatment, control (Group A). Hypertensive patients were treated with either ACE inhibitors (Group B,
n = 37), calcium antagonists (Group C,
n = 16), or both (Group D,
n = 10).
We found a significant reduction in IVUS indices of coronary vasculopathy in heart transplant recipients who used a combination of an ACE inhibitor and a calcium antagonist compared with recipients who used either drug alone (
p < 0.05). This synergistic efficacy was independent of the baseline indices evaluated in a multivariate regression analysis model and was noted despite comparable mean arterial pressure among the 3 hypertensive groups at 1 year, thus suggesting the presence of a synergistic anti-proliferative effect beyond the anti-hypertensive efficacy.
The combined use of an ACE inhibitor and a calcium antagonist is more effective than the individual use of either drug alone on the development of coronary vasculopathy in cardiac transplant recipients. Large randomized clinical trials are warranted to evaluate such a synergistic efficacy.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>16102438</pmid><doi>10.1016/j.healun.2004.06.005</doi><tpages>6</tpages></addata></record> |
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subjects | Aged Angiotensin-Converting Enzyme Inhibitors - administration & dosage Biological and medical sciences Calcium Channel Blockers - administration & dosage Cardiology. Vascular system Case-Control Studies Coronary Disease - diagnostic imaging Coronary Disease - drug therapy Coronary Disease - physiopathology Coronary heart disease Dose-Response Relationship, Drug Drug Administration Schedule Drug Therapy, Combination Female Follow-Up Studies Graft Rejection Graft Survival Heart Heart Transplantation - adverse effects Heart Transplantation - methods Humans Hypertension - complications Male Medical sciences Middle Aged Multivariate Analysis Postoperative Complications - diagnosis Postoperative Complications - drug therapy Probability Reference Values Severity of Illness Index Statistics, Nonparametric Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Survival Rate Treatment Outcome Ultrasonography, Interventional |
title | The Effect of Combined Angiotensin-Converting Enzyme Inhibition and Calcium Antagonism on Allograft Coronary Vasculopathy Validated by Intravascular Ultrasound |
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