METHOD OF TREATING ISOLATED SYSTOLIC HYPERTENSION

Abstract: This invention relates to the use of eprosartan to treat isolated systolic hypertension.

Description: Method of Treating Isolated Systolic Hypertension Field of the Invention This invention relates to the use of eprosartan, which is (E)-α-[2-n-butyl-l- [(4-carboxyphenyl)methyl]- lH-imidazol-5-yl]methylene-2-thiophenepropionic acid monomethanesulfonate, to treat isolated systolic hypertension. Background of the Invention The renin-angiotensin system plays a major role in the long-term control of blood pressure. Inhibition of this system with ACE inhibitors, and more recently angiotensin II (All) receptor antagonists, has provided important therapeutics for the treatment of hypertension. Additionally, it is known that the sympathetic nervous system plays an important role in blood pressure control. Indeed, sympathetic nervous system activity is a major determinant of systolic hypertension, which is now recognized as a significant risk factor for cardiovascular disease. The compound (E)-α- [2-n-butyl- 1 - [(4-carboxyphenyl)methy 1] - 1 H-imidazol- 5-yl]methylene-2-thiophenepropionic acid monomethanesulfonate is known by the name "eprosartan" and is the subject of U.S. Patent No. 5,185,351 (the 351 patent), issued February 9, 1993. This compound is a nonpeptide All receptor antagonist. Surprisingly, it has been found that eprosartan produced significant inhibition of the All-induced enhancement of the pressor response to sympathetic nervous system activity. This result is surprising since other nonpeptide All receptor antagonists, for example losartan, valsartan, and irbesartan, did not produce significant inhibition of this pressor response. Thus, eprosaran may be useful in the treatment of isolated systolic hypertension. Summary of the Invention The present invention provides a new method of treatment of isolated systolic hypertension in a mammal, in particular a man, which comprises administering to a subject in need thereof an effective amount of eprosartan. Detailed Description of the Invention Eprosartan, which is (E)-α-[2-n-butyl-l-[(4-carboxyphenyl)methyl]-lH- imidazol-5-yl]methylene-2-thiophenepropionic acid monomethanesulfonate, has the following structure: Eprosartan is claimed in U.S. Patent No. 5,185,351 (the 351 patent). Reference should be made to said patent for its full disclosure, including the methods of preparing this compound. The entire disclosure of the 351 patent is incorporated herein by reference. In accordance with the present invention, it has been unexpectedly found that eprosartan produced significant inhibition of the All-induced enhancement of the pressor response to sympathetic nervous system activity. This result is surprising, since other nonpeptide All receptor antagonists, for example losartan, valsartan, and irbesartan, did not produce significant inhibition of this pressor response. Thus, eprosaran may be useful in the treatment of isolated systolic hypertension. Systolic hypertension is a major risk factor for cardiovascular disease and is present in a majority of hypertensive patients. It is well known that the sympathetic nervous system plays pivotal role in determining systolic blood pressure. Since the renin-angiotensin system can enhance sympathetic nervous system activity, it is possible that the antihypertensive activity of the newly developed All receptor antagonists may involve prejunctional All receptors, in addition to blockade of vascular All receptors. According to the instant invention, a number of nonpeptide All receptors antagonists were evaluated for their ability to block prejunctional All receptors and sympathetic outflow. Blockade of All receptors with eprosartan resulted in a significant inhibition of the pressor response to spinal cord stimulation in the pithed rat. Several other nonpeptide All receptor antagonists failed to produce this response. Thus, administration of losartan, valsartan, and irbesartan at equivalent and effective doses did not have any effect on the frequency-response curves. These data suggest that there may be differential effects between eprosartan and losartan, valsartan and irbesartan on prejunctional All receptors. Thus, eprosartan, but not other nonpeptide All receptor antagonists, may be effective at treating isolated systolic hypertension. In the therapeutic use for the treatment of isolated systolic hypertension, eprosartan is incorporated into standard pharmaceutical compositions. It can be administered orally, parenterally, rectally, topically or transdermally. Eprosartan can be formulated as a liquid, for example a syrup, suspension or emulsion, in a tablet, capsule or lozenge. A liquid formulation will generally consist of a suspension or solution of eprosartan in a suitable liquid carrier(s) for example, ethanol, glycerine, non-aqueous solvent, for example, polyethylene glycol, oils, or water with a suspending agent, preservative, flavouring or colouring agent. A composition in the form of a tablet can be prepared using any suitable pharmaceutical carrier(s) routinely used for preparing solid formulations. Examples of such carriers include magnesium stearate, starch, lactose, sucrose and cellulose. A composition in the form of a capsule can be prepared using routine encapsulation procedures. For example, pellets containing the active ingredient can be prepared using standard carriers and then filled into a hard gelatin capsule; alternatively, a dispersion or suspension can be prepared using any suitable pharmaceutical carrier(s), for example aqueious gums, celluloses, silicates or oils and the dispersion or suspension then filled into a soft gelatin capsule. Eprosartan when administered parenterally (i.e. by injection of infusion) can be formulated as a solution or a suspension. A composition for parenteral administration will generally consist of a solution or suspension of eprosartan in a sterile aqueous carrier or parenterally acceptable oil, for example polyethylene glycol, polyvinyl pyrrolidone, lecithin, arachis oil or sesame oil. Alternatively, the solution can be lyophilised and then reconstituted with a suitable solvent just prior to administration. A typical suppository composition comprises eprosartan with a binding and/or lubricating agent such as polymeric glycols, gelatins or coca butter or other low melting vegetable or synthetic waxes or fats. A typical transdermal formulation comprises a conventional aqueous or non- aqueous vehicle, for example, a cream, ointment lotion or paste or in the form of a medicated plaster, patch or membrane. For topical administration, the pharmaceutical composition adapted includes solutions, suspensions, ointments, and solid inserts. Typical pharmaceutically acceptable carriers are, for example, water, mixtures of water and water-miscible solvents such as lower alkanols or vegetable oils, and water soluble ophthalmologically acceptable non-toxic polymers, for example, cellulose derivatives such as methyl cellulose. The pharmaceutical preparation may also contain non-toxic auxiliary substances such as emulsifying, preserving, wetting, and bodying agents, as for example, polyethylene glycols; antibacterial components such as quaternary ammonium compounds; buffering ingredients such as alkali metal chloride; antioxidants such as sodium metabisulfite; and other conventional ingredients such as sorbitan monolaurate. The present invention provides a pharmaceutical composition which comprises eprosartan and a pharmaceutically acceptable carrier. The pharmaceutical composition may be adapted for oral administration. This composition is presented as a unit dose pharmaceutical composition containing from about 50 mg to about 1.0 g of eprosartyan, preferably from about 200 to about 400 mg. Such a composition is normally taken from 1 to 4 times daily, preferably from 1 to 2 times daily. The preferred unit dosage forms include tablets or capsules. The compositions of this invention may be formulated by conventional methods of admixture such as blending, filling and compressing. Suitable pharmaceutically acceptable carriers for use in this invention include diluents, fillers, binders and disintegrants. No unacceptable toxicological effects are expected when eprosartan is administered in accordance with the present invention. The following example is illustrative of the instant invention. This example is not intended to limit the scope of this invention as defined hereinabove and as claimed hereinbelow. Example 1 Materials and Methods Spinal cord-stimulated pithed rats Normotensive male Sprague-Dawley rats (300-350 gm) were anesthetized with Bre vital (10 mg/kg, i.v.), a tracheostomy was performed and the rats were then pithed by inserting a steel rod (1.5 mm in diameter) through the orbit and foramen magnum into the spinal cord. Immediately after pithing, rats were ventilated artificially with room air using a rodent respirator at a frequency of 60 cycles/min with a volume of 2 ml/100 gm body weight. The pithing rod was insulated except for a 6-cm section distal from the tip. Body temperature was maintained at 37-38θc by a thermostatic heating pad. Animals were treated with tubocurararine (1 mg/kg, i.v) and atropine (1 mg/kg, i.v.), to prevent muscle movement during spinal cord stimulation and parasympathetic effects, respectively. Systemic arterial blood pressure was measured from the right carotid artery by a Statham P23 pressure transducer and recorded on a Grass polygraph. The left jugular vein was cannulated for i.v. administration of drugs. Stimulation of sympathetic vasomotor outflow was accomplished by a consecutive train of stimulation (50 V, 1 msec, 0.3-5.0 Hz) which was delivered for 15 sec at each frequency. Drugs were administered at 0.3 mg/kg, i.v. 10 min before the initiation of a second frequency-response curve. For all the compounds evaluated, this dose provided effective blockade of the pressor response to exogenous All (100 ng/kg, i.v.). Each rat served as its own control. Data analyses and statistics All data are shown as the means ± S.E.M. of the number (n) of observations. Statistical significance of the differences between drug-treated animals and vehicle- control animals was tested by a one-way analysis of variance with a P valued of 0.05 accepted as significant. Drugs All solutions were prepared daily. The following drugs were used: All, Sarl,Ile8[AII], atropine sulfate, (+)-tubocurarine chloride (Sigma Chemical Co.), eprosartan (U.S. Patent No. 5,185,351, issued February 9, 1993), losartan (U.S. Patent No. 5,138,069, issued August 11, 1992), valsartan (U.S. Patent No. 5,399,578, issued March 21, 1995) and irbesartan (U.S. Patent No. 5,270,317, issued December 14, 1993). Results Stimulation of the thoracolumbar sympathetic outflow in pithed rats produced frequency-dependent pressor responses. Administration of saline vehicle did not produce significant effects on the frequency-response curve. Continuous infusion of a sub-pressor dose of All (40 ng/kg/min) produced significant leftward shifts of the frequency-response curve, indicative of potentiation of sympathetic nervous system function. In contrast, continuous infusion of the peptide All receptor antagonist Sarl-Ile°[AII] (10 ug/kg/min) significantly inhibited the increase in pressor response to spinal cord stimulation. The effects of several nonpeptide All receptor antagonist were evaluated. Eprosartan (0.3 mg/kg, i.v.) produced significant inhibition of the pressor responses mediated by sympathetic nervous system activation. In contrast, neither losartan, valsartan, or irbesartan produced significant inhibition of the pressor responses mediated by spinal cord stimulation. It is to be understood that the invention is not limited to the embodiment illustrated hereinabove and the right is reserved to the illustrated embodiment and all modifications coming within the scope of the following claims. The various references to journals, patents and other publications which are cited herein comprise the state of the art and are incorporated herein by reference as though fully set forth.

Claims: What is claimed is: 1. A method of treating isolated systolic hypertension which comprises administering to a subject in need thereof an effective amount of eprosartan. 2. The use of eprosartan in the manufacture of a medicament for the treatment of isolated systolic hypertension. 3. A pharmaceutical composition for use in the treatment of isolated systolic hypertension which comprises eprosartan and a pharmaceutically acceptable carrier.

Inventors: BROOKS DAVID P, FEUERSTEIN GIORA Z, OHLSTEIN ELIOT H, RUFFOLO ROBERT R JR, BROOKS, DAVID, P., FEUERSTEIN, GIORA, Z., OHLSTEIN, ELIOT, H., RUFFOLO, ROBERT, R., JR.
Applicants: BROOKS DAVID P, FEUERSTEIN GIORA Z, OHLSTEIN ELIOT H, RUFFOLO ROBERT R JR, SMITHKLINE BEECHAM CORP, BROOKS, DAVID, P., FEUERSTEIN, GIORA, Z., OHLSTEIN, ELIOT, H., RUFFOLO, ROBERT, R., JR., SMITHKLINE BEECHAM CORPORATION
Application year: 1998
Main classification: A61K31
IPC codes: A61K31, A61P9