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  1. Article: Blocking aldosterone in heart failure.

    Shafiq, Moiz M / Miller, Alan B

    Therapeutic advances in cardiovascular disease

    2009  Volume 3, Issue 5, Page(s) 379–385

    Abstract: Fifty years after its discovery, aldosterone continues to stimulate interest as a therapeutic target. Early studies focused on aldosterone's actions on hypertension, the kidney, and electrolyte handling. More recently, its actions on the heart and ... ...

    Abstract Fifty years after its discovery, aldosterone continues to stimulate interest as a therapeutic target. Early studies focused on aldosterone's actions on hypertension, the kidney, and electrolyte handling. More recently, its actions on the heart and cardiovascular system have become more apparent. Aldosterone causes cardiac fibrosis and remodeling, and stimulates neurohormonal systems that adversely affect the cardiovascular system. Aldosterone antagonism attenuates these negative effects. Clinical studies have applied this science and demonstrated improved morbidity and mortality with aldosterone blockade, specifically in patients with chronic heart failure and patients who are postmyocardial infarction and with depressed left ventricular function. This article will address the pathophysiology of aldosterone in cardiac fibrosis and remodeling, review the current clinical trial data, and explore the application of aldosterone blockade in an expanded heart failure population. The Randomized Aldactone Evaluation Study showed that the aldosterone antagonist spironolactone reduced mortality when compared to placebo in patients with chronic advanced heart failure. Similarly, the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study demonstrated a significant reduction in mortality and hospitalizations for patients randomized to the aldosterone antagonist eplerenone. A more provocative question is whether aldosterone antagonism will afford the same protection in patient populations with heart failure and preserved left ventricular function. Clinical trials are underway, and results are eagerly awaited.
    MeSH term(s) Aldosterone/metabolism ; Cardiovascular Agents/therapeutic use ; Drug Therapy, Combination ; Fibrosis ; Heart Failure/drug therapy ; Heart Failure/metabolism ; Heart Failure/physiopathology ; Humans ; Mineralocorticoid Receptor Antagonists/therapeutic use ; Myocardium/metabolism ; Myocardium/pathology ; Spironolactone/analogs & derivatives ; Spironolactone/therapeutic use ; Treatment Outcome ; Ventricular Dysfunction, Left/drug therapy ; Ventricular Dysfunction, Left/metabolism ; Ventricular Dysfunction, Left/physiopathology ; Ventricular Remodeling/drug effects
    Chemical Substances Cardiovascular Agents ; Mineralocorticoid Receptor Antagonists ; Spironolactone (27O7W4T232) ; Aldosterone (4964P6T9RB) ; eplerenone (6995V82D0B)
    Language English
    Publishing date 2009-10
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2485062-7
    ISSN 1753-9455 ; 1753-9447
    ISSN (online) 1753-9455
    ISSN 1753-9447
    DOI 10.1177/1753944709341300
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Sympathetic neural mechanisms in human hypertension.

    Victor, Ronald G / Shafiq, Moiz M

    Current hypertension reports

    2008  Volume 10, Issue 3, Page(s) 241–247

    Abstract: Compared with substantial clinical research on the renin-angiotensin-aldosterone system (RAAS), much less is known about the importance of the sympathetic nervous system as a therapeutic target to slow the initiation and progression of human hypertension. ...

    Abstract Compared with substantial clinical research on the renin-angiotensin-aldosterone system (RAAS), much less is known about the importance of the sympathetic nervous system as a therapeutic target to slow the initiation and progression of human hypertension. Using microelectrode recordings of sympathetic activity and radiotracer measurements of regional norepinephrine spillover in hypertensive patients, recent research has advanced several provocative findings with novel--but still largely potential--therapeutic implications for clinical hypertension. These include a stronger scientific rationale for using 1) combined alpha/beta-blockers in the early phases of primary hypertension and obesity-related hypertension; 2) RAAS blockers as central sympatholytics in hypertension associated with chronic kidney disease; and 3) a higher dialysis dose--either nocturnal or short daily hemodialysis--to reduce uremic stimulation of a blood pressure--raising reflex arising in the failing kidneys. New outcomes trials are needed if we are to translate this largely theoretical body of research into clinical practice.
    MeSH term(s) Antihypertensive Agents/therapeutic use ; Disease Progression ; Humans ; Hypertension/diagnosis ; Hypertension/etiology ; Hypertension/metabolism ; Hypertension/physiopathology ; Kidney Failure, Chronic/prevention & control ; Neurotransmitter Agents/metabolism ; Obesity/complications ; Renin-Angiotensin System/drug effects ; Sympathetic Nervous System/metabolism
    Chemical Substances Antihypertensive Agents ; Neurotransmitter Agents
    Language English
    Publishing date 2008-09-03
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2057367-4
    ISSN 1534-3111 ; 1522-6417
    ISSN (online) 1534-3111
    ISSN 1522-6417
    DOI 10.1007/s11906-008-0045-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Transient myeloproliferative disorder.

    Moiz, Bushra / Shafiq, Maria

    Blood

    2012  Volume 120, Issue 24, Page(s) 4672

    MeSH term(s) Diagnosis, Differential ; Down Syndrome/complications ; Fatal Outcome ; Hepatomegaly/complications ; Humans ; Infant, Newborn ; Leukemia, Megakaryoblastic, Acute/blood ; Leukemia, Megakaryoblastic, Acute/diagnosis ; Male ; Myeloproliferative Disorders/blood ; Myeloproliferative Disorders/complications ; Myeloproliferative Disorders/diagnosis ; Splenomegaly/complications
    Language English
    Publishing date 2012-12-19
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 80069-7
    ISSN 1528-0020 ; 0006-4971
    ISSN (online) 1528-0020
    ISSN 0006-4971
    DOI 10.1182/blood-2012-07-440917
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Oral direct renin inhibition: premise, promise, and potential limitations of a new antihypertensive drug.

    Shafiq, Moiz M / Menon, Dileep V / Victor, Ronald G

    The American journal of medicine

    2008  Volume 121, Issue 4, Page(s) 265–271

    Abstract: The first oral direct renin inhibitor, aliskiren, recently received approval for the treatment of hypertension. This article addresses the premise, promise, and potential limitations of this new class of renin-angiotensin system inhibitor. Although ... ...

    Abstract The first oral direct renin inhibitor, aliskiren, recently received approval for the treatment of hypertension. This article addresses the premise, promise, and potential limitations of this new class of renin-angiotensin system inhibitor. Although aliskiren adds to a list of more than 100 drugs approved for the treatment of hypertension, its introduction into clinical medicine is of particular interest because of the novel mechanism of action: inhibition of renin's catalytic activity, the most proximal and rate-limiting step in renin-angiotensin system activation. By producing more complete renin-angiotensin system inhibition than with existing agents, direct renin inhibitors may afford greater protection from hypertensive complications. Other potential advantages include additional blood pressure reduction when used in combination therapy, a placebo-like side-effect profile, avid renal concentration, and long duration of action. Potential limitations include modest levels of blood pressure reduction that are equivalent to but not greater than angiotensin receptor blockers, reduced gastrointestinal absorption with a high-fat meal, and large reactive increases in renin secretion--the functional importance of which is under intense investigation. The results of outcomes trials are eagerly awaited.
    MeSH term(s) Administration, Oral ; Amides/therapeutic use ; Blood Pressure Determination/methods ; Drug Approval ; Female ; Follow-Up Studies ; Fumarates/therapeutic use ; Humans ; Hypertension/diagnosis ; Hypertension/drug therapy ; Male ; Randomized Controlled Trials as Topic ; Renin/antagonists & inhibitors ; Renin-Angiotensin System/drug effects ; Severity of Illness Index ; Treatment Outcome ; United States ; United States Food and Drug Administration
    Chemical Substances Amides ; Fumarates ; aliskiren (502FWN4Q32) ; Renin (EC 3.4.23.15)
    Language English
    Publishing date 2008-04-15
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 80015-6
    ISSN 1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
    ISSN (online) 1555-7162 ; 1873-2178
    ISSN 0002-9343 ; 1548-2766
    DOI 10.1016/j.amjmed.2007.11.016
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: A barber-based intervention for hypertension in African American men: design of a group randomized trial.

    Victor, Ronald G / Ravenell, Joseph E / Freeman, Anne / Bhat, Deepa G / Storm, Joy S / Shafiq, Moiz / Knowles, Patricia / Hannan, Peter J / Haley, Robert / Leonard, David

    American heart journal

    2008  Volume 157, Issue 1, Page(s) 30–36

    Abstract: Background: Barbershops constitute potential sites for community health promotion programs targeting hypertension (HTN) in African American men but such programs previously have not been formally evaluated.: Methods: A randomized trial ( ... ...

    Abstract Background: Barbershops constitute potential sites for community health promotion programs targeting hypertension (HTN) in African American men but such programs previously have not been formally evaluated.
    Methods: A randomized trial (ClinicalTrials.gov no. NCT00325533) will test whether a continuous HTN detection and medical referral program conducted by influential peers (barbers) in a receptive community setting (barbershops) can promote treatment-seeking behavior and thus lower blood pressure (BP) among the regular customers with HTN. Barbers will offer a BP check with each haircut and encourage appropriate medical referral using real stories of other customers modeling the desired behaviors. A cohort of 16 barbershops will go through a pretest/posttest group-randomization protocol. Serial cross-sectional data collection periods (10 weeks each) will be conducted by interviewers to obtain accurate snapshots of HTN control in each barbershop before and after 10 months of either barber-based intervention or no active intervention. The primary outcome is BP control: BP <135/85 mm Hg (nondiabetic subjects) and <130/80 mm Hg (diabetic subjects) measured in the barbershop during the 2 data collection periods. The multilevel analysis plan uses hierarchical models to assess the effect of covariates on HTN control and secondary outcomes while accounting for clustering of observations within barbershops.
    Conclusions: By linking community health promotion to the health care system, this program could serve as a new model for HTN control and cardiovascular risk reduction in African American men on a nationwide scale.
    MeSH term(s) Black or African American ; Barbering ; Community Networks ; Health Promotion/methods ; Humans ; Hypertension/prevention & control ; Male
    Language English
    Publishing date 2008-11-29
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 80026-0
    ISSN 1097-6744 ; 0002-8703
    ISSN (online) 1097-6744
    ISSN 0002-8703
    DOI 10.1016/j.ahj.2008.08.018
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  6. Article ; Online: Effectiveness of a barber-based intervention for improving hypertension control in black men: the BARBER-1 study: a cluster randomized trial.

    Victor, Ronald G / Ravenell, Joseph E / Freeman, Anne / Leonard, David / Bhat, Deepa G / Shafiq, Moiz / Knowles, Patricia / Storm, Joy S / Adhikari, Emily / Bibbins-Domingo, Kirsten / Coxson, Pamela G / Pletcher, Mark J / Hannan, Peter / Haley, Robert W

    Archives of internal medicine

    2010  Volume 171, Issue 4, Page(s) 342–350

    Abstract: Background: Barbershop-based hypertension (HTN) outreach programs for black men are becoming increasingly common, but whether they are an effective approach for improving HTN control remains uncertain.: Methods: To evaluate whether a continuous high ... ...

    Abstract Background: Barbershop-based hypertension (HTN) outreach programs for black men are becoming increasingly common, but whether they are an effective approach for improving HTN control remains uncertain.
    Methods: To evaluate whether a continuous high blood pressure (BP) monitoring and referral program conducted by barbers motivates male patrons with elevated BP to pursue physician follow-up, leading to improved HTN control, a cluster randomized trial (BARBER-1) of HTN control was conducted among black male patrons of 17 black-owned barbershops in Dallas County, Texas (March 2006-December 2008). Participants underwent 10-week baseline BP screening, and then study sites were randomized to a comparison group that received standard BP pamphlets (8 shops, 77 hypertensive patrons per shop) or an intervention group in which barbers continually offered BP checks with haircuts and promoted physician follow-up with sex-specific peer-based health messaging (9 shops, 75 hypertensive patrons per shop). After 10 months, follow-up data were obtained. The primary outcome measure was change in HTN control rate for each barbershop.
    Results: The HTN control rate increased more in intervention barbershops than in comparison barbershops (absolute group difference, 8.8% [95% confidence interval (CI), 0.8%-16.9%]) (P = .04); the intervention effect persisted after adjustment for covariates (P = .03). A marginal intervention effect was found for systolic BP change (absolute group difference, -2.5 mm Hg [95% CI, -5.3 to 0.3 mm Hg]) (P = .08).
    Conclusions: The effect of BP screening on HTN control among black male barbershop patrons was improved when barbers were enabled to become health educators, monitor BP, and promote physician follow-up. Further research is warranted.
    Trial registration: clinicaltrials.gov Identifier: NCT00325533.
    MeSH term(s) African Americans ; Barbering ; Blood Pressure Monitoring, Ambulatory ; Cluster Analysis ; Community-Institutional Relations ; Health Education ; Humans ; Hypertension/therapy ; Male ; Middle Aged ; Motivation ; Patient Acceptance of Health Care ; Referral and Consultation ; Texas
    Language English
    Publishing date 2010-10-25
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 211575-x
    ISSN 1538-3679 ; 0003-9926 ; 0888-2479 ; 0730-188X
    ISSN (online) 1538-3679
    ISSN 0003-9926 ; 0888-2479 ; 0730-188X
    DOI 10.1001/archinternmed.2010.390
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