The Role of Renin-Angiotensin System in Prothrombotic State in Essential Hypertension

Rheological, haemostatic, endothelial and platelet abnormalities appear to play a role in the thrombotic complications of hypertension. This prothrombotic/hypercoagulable state in hypertension may contribute to the increased risk and severity of target organ damage. It can be induced by the activated reninangiotensin system (RAS), with abnormalities in endothelial and platelet function, coagulation and fibrinolysis. Treatment of uncomplicated essential hypertension by RAS targeting antihypertensive therapy could result in a reversal of prothrombotic abnormalities, contributing to a reduction of thrombosis-related complications. Since angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have two distinct mechanisms of RAS interruption, it is hypothesized that each therapy might have different impact on the prothrombotic state in hypertensive patients. Some studies demonstrate a beneficial effect of both ACE inhibitors and ARBs on prothrombotic state, in addition to their efficacy to normalize elevated blood pressure. The potentially antithrombotic effect of the RAS inhibiting agents may in turn support the preservation of cardiovascular function. Available data may offer an additional explanation for the efficacy of the RAS targeting agents in the prevention of cardiovascular events in patients with atherosclerotic vascular disease.</jats:p

A comparative study of the molecular structure, lipophilicity, solubility, acidity, absorption and polar surface area of coumarinic anticoagulants and direct thrombin inhibitors

The methods of computational chemistry have been used to elucidate the molecular properties of coumarinic anticoagulants (acenocoumarol, phenprocoumon, warfarin and tecarfarin) and direct thrombin inhibitors (melagatran, dabigatran and their prodrug forms, ximelagatran and dabigatran etexilate). The geometries and energies of these drugs have been computed at the Becke3LYP/6-311++G(d,p) level of theory. In the case of the vitamin K antagonists (acenocoumarol, phenprocoumon, warfarin and tecarfarin), the most stable tautomer in both the gas-phase and water solution is tautomer A, which contains the 4-hydroxycoumarin moiety. The R(+)-enantiomer of this tautomer is the most stable structure in warfarin and acetocoumarol. For phenprocoumon, the S(-)-enantiomer was the most stable species. The computed dissociation constants show that these drugs are almost completely ionized at physiological pH = 7.4. Tecarfarin is the vitamin K antagonist with the highest lipophilicity. The prodrugs ximelagatran and dabigatran etexilate are described as lipophilic drugs. The prodrugs' metabolites, melagatran and dabigatran, are substantially less lipophilic. The relatively high polar surface area value of acenocoumarol (113.3) results in lessened absorption in comparison with warfarin. Phenprocoumon, with PSA value 50.4, had the highest calculated absorption of all of the anticoagulants in the study. The direct thrombin inhibitors, melagatran and dabigatran, have a high total number of proton donor and proton acceptor groups (15), a high PSA (150) and the lowest absorption of the drugs studied