Pedro Joya-Vazquez hai et al Research Article
IJPR Volume 4 Issue 3 (2014) 146
concentration-dependent, reversible and reproducible relaxations of human artery internal mammary. The mechanism of
this effect on arterial tree can be explained by the regulation of intracellular Ca2+.3,4 Other potential pathway involves PPI
interactions with cardiovascular drugs3,4. PPI are CYP2C9 and CYP2C19 moderate inhibitors which may reduce the
metabolism of the substrates of this pathways (i.e. losartan, torasemide or some beta-blockers) and serum concentrations
could increase3. In another side, other data do not support the fact that PPI use may have a significant and inmediate
impact on hemodynamic parameters in a high-risk intensive care setting17. However this has not been studied in patients
who were clinically stable in the daily practice.
The ABPM shows that patients who take PPI had a lower SBP and DBP than those who do not take PPI drugs.
The reduction of BP was similar in day and night values. These findings suggest that PPI therapy in hypertensive patients
may be associated with a small – but significant – reduction of the average blood pressure in 24 hours. However, this
reduction of less than 5 mmHg systolic BP not seems to be important enough to provide cardiovascular protection in the
subgroup of patients with advanced cardiovascular disease3. Whatever we do not know whether this effect could be
maintained steadily over time.
PPI users had ischemic cardiovascular disease, diabetes, atrial fibrillation or microalbuminuria more often than
nonusers. These patients are considered to be high risk patients, and current guidelines establish more aggressive
therapeutic objectives and the use of antithrombotic therapy which advise for the treatment with PPIs for preventing
digestive disease. This might suggest that PPI therapy is a bias result to an aggressive treatment in a highly motivated
group of patients, mostly after myocardial infarction. Although all patients have been recommended with a reduction of
salt intake in their diets, the monitoring of this recommendation should have been contrasted. Beside the previous stated, a
higher use of diuretics in the PPI group can make a significant difference in BP control.
The main limitation of this observational study is that it is based on a database of ABPM. We are aware that this
study does not provide the guarantees of a controlled prospective study and that this type of disease is an extremely
complex disease and there are many factors that can influence and beyond those provided in the analysis should be
thought. And what could be considered a bias is rather strength of the study. Because patients with major cardiovascular
damage are undoubtedly aware, are often better treatment compliers; promoting better control of blood pressure. It could
not to tip the balance towards a potential protective effect for the use of PPIs. And although, it seems undeniable
hypotensive effect of PPIs at least in the short term. Our study was unable to demonstrate that the differences could have a
beneficial clinical impact, as would have been desirable to find.
To date, know the publications of other studies that are intended to look at the impact of PPIs in controlling BP in
clinical practice are lacking. But perhaps the mayor interest of this trial is that we could assess the extent to which the use
of IBP through its hypotensive effect could have a clinically relevant protective effect of cardiovascular standpoint. When,
we were able to compare hypertensive patients with different degrees of cardiovascular damage. Moreover there are a lot
questions unanswered that remain. We do not know with certainty which could be the threshold needed in reducing SBP
and / or BDP and this value remains unchanged regardless of cardiovascular risk. If indication of IBP is common and
observations tend to emerge about unexpected benefits of the drug, and if a reasonable biologic rationale can be profferes,
trialists take the next logical step and devise a randomized, controlles trial to determine whether a causal relationship
clinical outcome can be shown.
This study offers insights into factors associated with better BP control with an unselected patient population, in
contrast to the rigorously controlled conditions of randomized clinical studies. It provides feedback from real-world
clinical situations. Probably our main issue is that our experience endorses the fact that PPIs could contribute to a better
control of BP in patients with cardiovascular risk. Encouraging conducting controlled studies that can respond to the many
In conclusion, this study raises the possibility that PPI therapy reduces the BP among patients with hypertension.
However, our findings do not support the hypothesis of this effect may provide cardiovascular protection. Possibly in part
to a diminished response of impaired vascular tree, by interaction with a greater number of drugs and certainly by factors
that we still are unknown.
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