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Yeni Tanı Almış Yetişkin Hipertansif Hastalarda, Amlodipin ve Valsartan Tedavisinin Kemik Yapım-Yıkım Belirteçleri ve OPG/RANKL/RANK Sistemi Üzerine Etkisi; Hangisi daha Faydalı?

Infl uences of Treatment with Amlodipine and Valsartan on Bone Turnover Markers and OPG/RANKL/RANK System in Newly Diagnosed Hypertensive Adults; Which is more Benefi cial?

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DOI: 
10.5262/tndt.2014.1001.08
Abstract (2. Language): 
We aimed to investigate the effects of treatment with amlodipine and valsartan, on markers of bone remodeling in newly diagnosed hypertensive adults. Forty-three subjects with newly diagnosed were included in the study. Patients were also randomly divided into two groups, and each group received monotherapy with amlodipine or valsartan. Blood levels of bone turnover markers and osteoprotegerin (OPG) / receptor activator of nuclear factor-κB ligand (RANKL) / RANK system were measured. Amlodipine reduced sRANKL levels and sRANKL/OPG ratio more than valsartan, and this decrease was statistically signifi cant (p<0.001, p=0.002, respectively). Although blood OPG concentration did not change after treatment in both groups, sRANKL/OPG ratio decreased signifi cantly (p<0.001). Amlodipine also caused some reduction in CTx blood levels compared to valsartan. So we can suggest that amlodipine may be a better option than valsartan in patients with osteoporosis or terms of prevention of bone loss in hypertensive adults.
Abstract (Original Language): 
Bu çalışmada amacımız; yeni tanı almış, yetişkin hipertansif hastalarda Amlodipin ve Valsartan tedavisinin kemik yeniden şekillendirilmesi (remodeling) üzerine olan etkisini araştırmaktır. Çalışmaya daha önce tedavi almamış 43 yeni tanılı hasta alındı.Hastalar rastgele iki gruba ayrıldı. Her bir gruba monoterapi şeklinde Amlodipin ve Valsartan verildi. Kemik yapım-yıkım belirteçleri yanında osteoprotegerin (OPG) / nükleer faktör kappa-B reseptör aktivatörü ve ligand(sRANKL) / RANK sistemi çalışıldı. Amlodipin kolunda sRANKL düzeyinin ve sRANKL/OPG oranınının valsartandan daha fazla azaldığı ve bunun istatistiki açıdan anlamlı olduğu görüldü (p<0.001, p=0.002, sırasıyla). Tedavi sonrası her iki grupta da OPG konsantrasyonu değişmemekle birlikte sRANKL/OPG oranının anlamlı şekilde azaldığı görüldü (p<0.001). Yine Amlodipinin C-telopeptide of type I collagen(CTx ) düzeyini Valsartana göre daha fazla azalttığı görüldü. Bu veriler ışığında, osteoprotik hastalarda veya kemik kaybı yönünden risk taşıyan hastalarda amlodipin tedavisinin valsartan tedavisine göre daha iyi bir seçim olabileceğini söyleyebiliriz.
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REFERENCES

References: 

1. Caudarella R, Vescini F, Rizzoli E, Francucci CM: Salt intake,
hypertension, and osteoporosis. J Endocrinol Invest 2009; 32: 15-20
2. Resnick LM, Laragh JH, Sealey JE, Alderman MH: Divalent
cations in essential hypertension: Relations between serum ionized
calcium, magnesium, and plasma renin activity. N Engl J Med 1983;
309: 888-891
3. Cappuccio FP, Kalaitzidis R, Duneclift S, Eastwood JB: Unravelling
the links between calcium excretion, salt intake, hypertension,
kidney stones and bone metabolism. J Nephrol 2000; 13: 169-177
4. Cappuccio FP, Meilahn E, Zmuda JM, Cauley JA: High blood
pressure and bone-mineral loss in elderly white women: A
prospective study. Study of Osteoporotic Fractures Research Group.
Lancet 1999; 354: 971-975
5. Schlienger RG, Kraenzlin ME, Jick SS, Meier CR: Use of betablockers
and risk of fractures. JAMA 2004; 292: 1326-1332
6. Rejnmark L, Vestergaard P, Mosekilde L: Treatment with betablockers,
ACE inhibitors, and calcium-channel blockers is
associated with a reduced fracture risk: A nationwide case-control
study. J Hypertens 2006; 24: 581-589
7. Nishiya Y, Sugimoto S: Effects of various antihypertensive drugs on
the function of osteoblast. Biol Pharm Bull 2001; 24(6): 628-633
8. Ritchie CK, Maercklein PB, Fitzpatrick LA: Direct effect of calcium
channel antagonists on osteoclast function: Alterations in bone
resorption and intracellular calcium concentrations. Endocrinology
1994; 135(3): 996-1003
9. Halici Z, Borekci B, Ozdemir Y, Cadirci E, Suleyman H: Protective
effects of amlodipine and lacidipine on ovariectomy-induced bone
loss in rats. Eur J Pharmacol 2008; 579(1-3): 241-245
10. Gradosova I, Zivna H, Palicka V, Hubena S, Svejkovska K,
Zivny P: Protective effect of amlodipine on rat bone tissue after
orchidectomy. Pharmacology 2012; 89 (1-2): 37-43
11. Ruilope LM, Segura J: The importance of integrated risk
management when treating patients with hypertension: Benefi ts
of angiotensin II receptor antagonist therapy. Clin Exp Hypertens
2008; 30: 397-414
12. Broulík PD, Tesar V, Zima T, Jirsa M: Impact of antihypertensive
therapy on the skeleton: Effects of enalapril and AT1 receptor
antagonist losartan in female rats. Physiol Res 2001; 50: 353-358
13. Shimizu H, Nakagami H, Osako MK, Hanayama R, Kunugiza
Y, Kizawa T, Tomita T, Yoshikawa H, Ogihara T, Morishita R:
Angiotensin II accelerates osteoporosis by activating osteoclasts.
FASEB J 2008; 22: 2465-2475
14. Izu Y, Mizoguchi F, Kawamata A, Hayata T, Nakamoto T,
Nakashima K, Inagami T, Ezura Y, Noda M: Angiotensin II type
2 receptor blockade increases bone mass. J Biol Chem 2009; 284:
4857-4864
15. Li YQ, Ji H, Shen Y, Ding LJ, Zhuang P, Yang YL, Huang QJ:
Chronic treatment with angiotensin AT1 receptor antagonists
reduced serum but not bone TGF-beta1 levels in ovariectomized
rats. Can J Physiol Pharmacol 2009; 87(1): 51-5516. Hiruma Y, Inoue A, Hirose S, Hagiwara H: Angiotensin II stimulates
the proliferation of osteoblast-rich populations of cells from rat
calvariae. Biochem Biophys Res Commun 1997;230:176-178
17. Trouvin AP, Goëb V: Receptor activator of nuclear factor-κB ligand
and osteoprotegerin: Maintaining the balance to prevent bone loss.
Clin Interv Aging 2010; 5: 345-354
18. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA,
Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella
EJ; National Heart, Lung, and Blood Institute Joint National
Committee on Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure; National High Blood Pressure Education
Program Coordinating Committee: The Seventh Report of the Joint
National Committee on prevention, detection, evaluation, and
treatment of high blood pressure: The JNC 7 report. JAMA 2003;
289: 2560-2572
19. Akatsu T, Takahashi N, Udagawa N, Sato K, Nagata N, Moseley JM,
Martin TJ, Suda T: Parathyroid hormone (PTH)-related protein is a
potent stimulator of osteoclast-like multinucleated cell formation to
the same extent as PTH in mouse marrow cultures. Endocrinology
1989; 125(1): 20-27
20. Ushijima K, Liu Y, Maekawa T, Ishikawa E, Motosugi Y, Ando H,
Tsuruoka S, Fujimura A: Protective effect of amlodipine against
osteoporosis in stroke-prone spontaneously hypertensive rats. Eur
J Pharmacol 2010; 635: 227-230
21. Shimizu H, Nakagami H, Yasumasa N, Mariana OK, Kyutoku M,
Koriyama H, Nakagami F, Shimamura M, Rakugi H, Morishita
R: Cilnidipine, but not amlodipine, ameliorates osteoporosis in
ovariectomized hypertensive rats through inhibition of the N-type
calcium channel. Hypertens Res 2012; 35(1): 77-81
22. Kosaka N, Uchii M: Effect of benidipine hydrochloride, a
dihydropyridine-type calcium antagonist, on the function of mouse
osteoblastic cells. Calcif Tissue Int 1998; 62(6): 554-556
23. Zahanich I, Graf EM, Heubach JF, Hempel U, Boxberger S, Ravens
U: Molecular and functional expression of voltage-operated calcium
channels during osteogenic differentiation of human mesenchymal
stem cells. J Bone Miner Res 2005; 20(9): 1637-1646
24. Manolagas SC: Birth and death of bone cells: Basic regulatory
mechanisms and implications for the pathogenesis and treatment of
osteoporosis. Endocr Rev 2000; 21(2): 115-137
25. Ma L, Ji JL, Ji H, Yu X, Ding LJ, Liu K, Li YQ: Telmisartan
alleviates rosiglitazone-induced bone loss in ovariectomized
spontaneous hypertensive rats. Bone 2010; 47: 5-11
26. Asaba Y, Ito M, Fumoto T, Watanabe K, Fukuhara R, Takeshita
S, Nimura Y, Ishida J, Fukamizu A, Ikeda K: Activation of
renin-angiotensin system induces osteoporosis independently of
hypertension. J Bone Miner Res 2009; 24(2): 241-250
27. Kwok T, Leung J, Zhang YF, Bauer D, Ensrud KE, Barrett-Connor
E, Leung PC; Osteoporotic Fractures in Men (MrOS) Research
Group: Does the use of ACE inhibitors or angiotensin receptor
blockers affect bone loss in older men? Osteoporos Int 2012; 23(8):
2159-2167

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