Summertime Dosage-dependent Hypersensitivity to an Angiotensin II Receptor Blocker

Overview

Journal BMC Res Notes

Publisher Biomed Central

Specialties Biology
General Medicine

Date 2015 Jun 10

PMID 26055103

Citations 3

Authors

Donald R Forsdyke

Affiliations

Soon will be listed here.

Abstract

Background: Summertime dips in blood pressure (BP), both in normotensive and hypertensive subjects, are well known. However, the dips are small and are not related to particular forms or doses of antihypertensive medication. Nevertheless it is the practice in some quarters to decrease antihypertensive medication in summer, and/or to increase in winter. Large scale studies being inconclusive, there are calls for long-term examination of the relationship between environmental temperature and blood pressure in single individuals under medication.

Case Presentation: While analyzing data from a subject whose BP had been controlled for a decade with the angiotensin-II receptor blocker losartan, an extreme, dosage-dependent, summertime dip came to light. Downward dosage adjustment appeared essential and may have prevented hypotension-related pathology.

Conclusion: The benefits of aggressive medication (the "J curve" phenomenon) being debated, the possibility of seasonal hypersensitivity, perhaps explicable in terms of differential signaling by countervailing receptors, should be taken into account when considering dosage adjustments in hypertensive subjects.

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References

de Gasparo M, Catt K, Inagami T, Wright J, Unger T . International union of pharmacology. XXIII. The angiotensin II receptors. Pharmacol Rev. 2000; 52(3):415-72. View

Tang K, Wang G, Lu P, Karas R, Aronovitz M, Heximer S . Regulator of G-protein signaling-2 mediates vascular smooth muscle relaxation and blood pressure. Nat Med. 2003; 9(12):1506-12. DOI: 10.1038/nm958. View

Kristal-Boneh E, Froom P, Harari G, Shapiro Y, Green M . Seasonal changes in red blood cell parameters. Br J Haematol. 1993; 85(3):603-7. DOI: 10.1111/j.1365-2141.1993.tb03354.x. View

Siderovski D, Heximer S, Forsdyke D . A human gene encoding a putative basic helix-loop-helix phosphoprotein whose mRNA increases rapidly in cycloheximide-treated blood mononuclear cells. DNA Cell Biol. 1994; 13(2):125-47. DOI: 10.1089/dna.1994.13.125. View

Lo M, Goldberg M, McCrea J, Lu H, Furtek C, Bjornsson T . Pharmacokinetics of losartan, an angiotensin II receptor antagonist, and its active metabolite EXP3174 in humans. Clin Pharmacol Ther. 1995; 58(6):641-9. DOI: 10.1016/0009-9236(95)90020-9. View

Matsubara H . Pathophysiological role of angiotensin II type 2 receptor in cardiovascular and renal diseases. Circ Res. 1998; 83(12):1182-91. DOI: 10.1161/01.res.83.12.1182. View

Cosentino F, Savoia C, De Paolis P, Francia P, Russo A, Maffei A . Angiotensin II type 2 receptors contribute to vascular responses in spontaneously hypertensive rats treated with angiotensin II type 1 receptor antagonists. Am J Hypertens. 2005; 18(4 Pt 1):493-9. DOI: 10.1016/j.amjhyper.2004.11.007. View

Savoia C, Tabet F, Yao G, Schiffrin E, Touyz R . Negative regulation of RhoA/Rho kinase by angiotensin II type 2 receptor in vascular smooth muscle cells: role in angiotensin II-induced vasodilation in stroke-prone spontaneously hypertensive rats. J Hypertens. 2005; 23(5):1037-45. DOI: 10.1097/01.hjh.0000166845.49850.39. View

Verberk W, Kroon A, Lenders J, Kessels A, van Montfrans G, Smit A . Self-measurement of blood pressure at home reduces the need for antihypertensive drugs: a randomized, controlled trial. Hypertension. 2007; 50(6):1019-25. DOI: 10.1161/HYPERTENSIONAHA.107.094193. View

10.

Konstam M, Neaton J, Dickstein K, Drexler H, Komajda M, Martinez F . Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial. Lancet. 2009; 374(9704):1840-8. DOI: 10.1016/S0140-6736(09)61913-9. View

11.

Parati G, Bilo G . Evening administration of antihypertensive drugs: filling a knowledge gap. J Hypertens. 2010; 28(7):1390-2. DOI: 10.1097/HJH.0b013e32833c131d. View

12.

Hozawa A, Kuriyama S, Shimazu T, Ohmori-Matsuda K, Tsuji I . Seasonal variation in home blood pressure measurements and relation to outside temperature in Japan. Clin Exp Hypertens. 2011; 33(3):153-8. DOI: 10.3109/10641963.2010.531841. View

13.

Handler J . Seasonal variability of blood pressure in California. J Clin Hypertens (Greenwich). 2011; 13(11):856-60. PMC: 8816493. DOI: 10.1111/j.1751-7176.2011.00537.x. View

14.

Cuspidi C, Ochoa J, Parati G . Seasonal variations in blood pressure: a complex phenomenon. J Hypertens. 2012; 30(7):1315-20. DOI: 10.1097/HJH.0b013e328355d7f9. View

15.

Fedecostante M, Barbatelli P, Guerra F, Espinosa E, Dessi-Fulgheri P, Sarzani R . Summer does not always mean lower: seasonality of 24 h, daytime, and night-time blood pressure. J Hypertens. 2012; 30(7):1392-8. DOI: 10.1097/HJH.0b013e328354668a. View

16.

Lewington S, Li L, Sherliker P, Guo Y, Millwood I, Bian Z . Seasonal variation in blood pressure and its relationship with outdoor temperature in 10 diverse regions of China: the China Kadoorie Biobank. J Hypertens. 2012; 30(7):1383-91. PMC: 4344838. DOI: 10.1097/HJH.0b013e32835465b5. View

17.

Schutte R, Thijs L, Liu Y, Asayama K, Jin Y, Odili A . Within-subject blood pressure level--not variability--predicts fatal and nonfatal outcomes in a general population. Hypertension. 2012; 60(5):1138-47. PMC: 3607229. DOI: 10.1161/HYPERTENSIONAHA.112.202143. View

18.

McCarthy C, Widdop R, Denton K, Jones E . Update on the angiotensin AT(2) receptor. Curr Hypertens Rep. 2012; 15(1):25-30. DOI: 10.1007/s11906-012-0321-4. View

19.

Schalekamp M, Danser A . How does the angiotensin II type 1 receptor 'trump' the type 2 receptor in blood pressure control?. J Hypertens. 2013; 31(4):705-12. DOI: 10.1097/HJH.0b013e32835d6d11. View

20.

Modesti P, Morabito M, Massetti L, Rapi S, Orlandini S, Mancia G . Seasonal blood pressure changes: an independent relationship with temperature and daylight hours. Hypertension. 2013; 61(4):908-14. DOI: 10.1161/HYPERTENSIONAHA.111.00315. View