CAT ASCOT Atenolol and NOD
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The document summarizes a clinical trial that compared the blood pressure medication amlodipine to atenolol. The trial found that amlodipine was superior to atenolol in preventing cardiovascular events and reducing the risk of new-onset diabetes. Patients taking atenolol had a higher rate of developing diabetes compared to those taking amlodipine. Therefore, the author recommends switching patients from atenolol to amlodipine to better manage cardiovascular risks and reduce the risk of diabetes.
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1) The document summarizes the results of a large clinical trial testing the fixed-dose combination drug Preterax (perindopril and indapamide) for the treatment of type 2 diabetes patients.
2) The trial found that Preterax reduced the risk of cardiovascular mortality by 18%, total mortality by 14%, and the combined outcome of major macrovascular or microvascular events by 9% compared to placebo.
3) The beneficial effects of Preterax were consistent across patient subgroups and backgrounds in ancillary treatments.
Hypertension guidelines ESH ESC 2013
This document summarizes guidelines from the ESH/ESC 2013 on hypertension. It defines classifications of blood pressure levels and goals for treatment. It emphasizes ambulatory blood pressure monitoring which provides more measurements outside of the medical environment. Lifestyle changes like reducing salt intake, weight loss, and exercise are recommended initially for several months. Drug treatment is advised based on blood pressure level and cardiovascular risk factors. Combination drug treatment may be used for high-risk patients. Renal denervation is noted as a promising but unproven therapy requiring more study on safety and efficacy.
Hypertension Guidelines JNC 8
This document summarizes guidelines from the Eighth Joint National Committee (JNC 8) on the prevention, detection, evaluation, and treatment of high blood pressure. It provides recommendations on when to initiate pharmacologic treatment based on age, race, presence of diabetes or chronic kidney disease. It recommends treating to a blood pressure goal of less than 150/90 mmHg for those aged 60 or older, and less than 140/90 mmHg for others. It also provides guidance on first-line antihypertensive drug classes based on patient characteristics.
Oncopharmacoeconomy ii, Prof. Dr. F. Cankat Tulunay
The document discusses pharmacoeconomic analysis and clinical trials. Pharmacoeconomic analysis is more concerned with what happens in real-life settings, examines effectiveness, and measures outcomes like resource consumption and quality of life. Clinical trials focus on efficacy and safety in a controlled setting. The document provides examples of pharmacoeconomic thresholds used to determine cost-effectiveness of treatments, such as $50,000 per QALY gained, and discusses value-based pricing models.
Calcium Channel Blockers in Hypertension
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updates in Hypertension according to ESC guidelines 2013
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lipid effects of antihypertensive medications
The document summarizes key points from the 2017 ACC/AHA Hypertension Guidelines, including introducing new blood pressure definitions and calculating cardiovascular risk to determine treatment goals. It outlines recommending four classes of antihypertensive medications as first-line treatment, with beta-blockers no longer recommended as first-line unless indicated. The document also reviews blood pressure measurement techniques and emphasizing lifestyle modifications like diet and exercise.
Recent Developments in the Treatment of Hypertension Recent Developments in...
This document summarizes recent evidence from clinical trials on the treatment of hypertension, with a focus on patients with type 2 diabetes. It discusses trials comparing different classes of antihypertensive drugs and levels of blood pressure control. The evidence suggests that ACE inhibitors may provide greater benefits for diabetic patients compared to other drugs, reducing cardiovascular events and slowing kidney and eye disease progression. Intensive blood pressure control is also supported, though some calcium channel blockers may increase cardiovascular risk in diabetes. Ongoing long-term safety documentation is still needed for many antihypertensive agents.
Courage Trial
The COURAGE trial compared optimal medical therapy alone versus optimal medical therapy plus percutaneous coronary intervention (PCI) in patients with stable coronary artery disease. The trial found that after a median follow-up of 4.6 years, adding PCI to optimal medical therapy did not reduce the risk of death or non-fatal myocardial infarction compared to optimal medical therapy alone. Optimal medical therapy included antiplatelet therapy, anti-ischemic drugs, statins, and lifestyle modifications. The COURAGE trial demonstrated that PCI did not provide additional benefits beyond medical therapy for stable coronary disease patients.
EG_Non product related Cardiovascular_16.04.2021_Dr Beats_Dr Taimour Moustaf...
This document discusses the combination of drugs for treating hypertension. It outlines the role of the sympathetic nervous system and increased heart rate in hypertension and cardiovascular risk. It presents evidence that modern beta-1 selective blockers in combination with long-acting calcium antagonists like amlodipine are an ideal single-pill combination for treating hypertension. The data shows that this combination effectively lowers blood pressure and reduces cardiovascular events more than other drug combinations.
Heartbeat 167 October 2015 HBP
The SPRINT study found that treating systolic blood pressure to 120 mm Hg rather than 140 mm Hg significantly reduced mortality and cardiovascular events such as heart attack and stroke. This challenges the current JNC 8 guideline target of 140 mm Hg and below. The PATHWAY2 study found that adding spironolactone was more effective at reducing blood pressure than other drugs for patients resistant to three-drug treatment. Research also showed that ACE inhibitors resulted in poorer cardiovascular outcomes for black hypertensive patients compared to other antihypertensive drugs.
2008.02.12 Massie Hyperlipidemia
This document summarizes the key points from a lipidology conference presentation. It discusses recent guidelines and studies on cholesterol treatment, including more aggressive LDL lowering to under 70mg/dl for patients with cardiovascular disease. New tools for general cardiovascular risk prediction were presented. Treatment with high-dose statins was found to significantly reduce stroke recurrence and other outcomes for patients who had a stroke or TIA within the past 1-6 months. Immediate withdrawal of statins after acute stroke was associated with increased risks.
Carvedilol in the management of mi and heart failure
This document summarizes clinical studies comparing the effects of carvedilol and metoprolol in patients with myocardial infarction (MI) and heart failure (HF). Several studies found that carvedilol improved outcomes more than metoprolol, reducing mortality, improving quality of life, and decreasing hospital readmissions in post-MI and HF patients. Carvedilol's multi-receptor blocking properties allow it to provide better sympatholytic effects than metoprolol. The document concludes that carvedilol is a better choice than metoprolol for treating patients with MI or HF.
Newer Approach in management of Angina & CHF: Heart rate modulation and beyond..
1) A study evaluated the addition of ivabradine to metoprolol in patients with stable angina pectoris and found that it significantly reduced mean resting heart rate, weekly angina attacks, and use of short-acting nitrates over 4 months compared to baseline.
2) The mean heart rate fell by 19.7 bpm, weekly angina attacks decreased 8-fold, and quality of life scores increased with the combination therapy.
3) Heart rate reductions and clinical benefits were greater in patients who had higher baseline heart rates of 70 bpm or more.
Are all ACE inhibitors ace in treatment of essential hypertension?
This document summarizes a study that reviewed evidence on the effectiveness of different ACE inhibitors (ACEis) for treating essential hypertension. The study found:
1) No trials directly compared the main ACEis prescribed in England (ramipril, lisinopril, perindopril, enalapril).
2) Lisinopril is the only ACEi shown to be as effective as thiazide diuretics for outcomes like mortality, though it was inferior for stroke prevention.
3) Evidence suggests ramipril may be better than placebo for hypertension treatment and prevention, but the evidence is indirect.
4) Perindopril showed no benefit over placebo for hypertension treatment or
mono-therapy vs. combination therapy in hypertension
Initial combination therapy is superior to sequential mono-therapy for treating hypertension. Combination therapy controls blood pressure faster by acting on multiple mechanisms, reducing complications by 40-54%. Combinations have greater efficacy, improve adherence, and have protective effects beyond blood pressure lowering like anti-inflammatory and metabolic benefits. Clinical trials show combination therapy achieves better blood pressure control rates and lowers cardiovascular events compared to mono-therapy. Therefore, guidelines recommend starting treatment for hypertension with initial combination therapy.
ACC 2020 UPDATES
- A study evaluated the efficacy and safety of alirocumab in adults with homozygous familial hypercholesterolemia.
- 45 patients received alirocumab and 24 received placebo for 78 weeks.
- Alirocumab reduced LDL-C levels by 24.8% compared to placebo and was well tolerated, with adverse events similar between groups.
- Alirocumab provided clinically significant LDL-C lowering in patients with homozygous familial hypercholesterolemia.
Blood pressure guide
This document summarizes guidelines from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII). It provides recommendations on lifestyle modifications, measurement of blood pressure, causes and treatment of hypertension, and evidence from clinical trials on blood pressure control. The key recommendations include lifestyle modifications like weight loss, following the DASH diet, reducing sodium, regular exercise, and moderate alcohol intake to control blood pressure. It also provides guidance on drug therapy based on blood pressure levels and number of medications typically needed to achieve control.
Optimizing the traetment of hypertensive patients with dyslipidaemia algarv...
1) Treating both hypertension and dyslipidemia together provides greater reduction in cardiovascular events than treating either condition alone, as shown in the ASCOT trial.
2) While lowering blood pressure and lipids significantly reduces cardiovascular risk as demonstrated in multiple clinical trials, current treatment and control rates globally remain inadequate.
3) Concerns about statin safety have been overstated and discontinuing statin therapy has been linked to increased cardiovascular events and mortality.
JNC8-Chlorthalidone
1) The document discusses guidelines from JNC VIII for treating hypertension, recommending thiazide-type diuretics such as chlorthalidone as first-line treatment for most patients.
2) Landmark trials such as SHEP, ALLHAT and MRFIT found chlorthalidone to be more effective than other drugs at reducing cardiovascular events like stroke and heart failure.
3) Chlorthalidone has a long half-life allowing once daily dosing and has been shown to maintain its efficacy even at low doses with fewer side effects compared to other diuretics.
Thuốc điều trị tăng huyết áp trên bệnh thận đái tháo đường - BS Phạm Văn Bù...
This document discusses hypertension and its effects on the kidney. It provides an overview of key considerations in the pathophysiology of hypertension, including the roles of the renin-angiotensin-aldosterone system and other factors. Several studies are summarized that examine the use of diuretics and other antihypertensive drugs to control blood pressure and reduce proteinuria in patients with chronic kidney disease. Angiotensin receptor blockers are highlighted as effective treatments for slowing the progression of kidney disease through blood pressure control and additional renoprotective effects.
Hypertensive Dyslipidaemics
The document discusses treatment of hypertensive patients who also have dyslipidemia. It describes a case study of a 57-year-old man with prior myocardial infarction, uncontrolled hypertension, and elevated LDL cholesterol. Clinical trials show that intensive statin therapy to achieve lower LDL levels reduces cardiovascular risks more than moderate statin therapy. The Heart Protection Study also found that simvastatin reduced cardiovascular events in high-risk patients, regardless of baseline LDL level.
Managing Hypertension in Primary Care
In this overview, we draw inspiration from the article titled "Managing Hypertension in Primary Care“, published in the Canadian Family Physician journal (Vol 65: October 2019).
The article, edited by Khrystine Waked PharmD, Jeff Nagge PharmD, and Kelly Grindrod PharmD MSc,.
It provides valuable insights and evidence-based approaches to tackle Hypertension Management In Primary Care.
By incorporating the recommendations discussed in this article, we can enhance our ability to manage hypertension and ultimately improving patient outcomes and quality of life.
Hypertension Overview
1) Hypertension is poorly managed in the US, with only about 30% of patients achieving blood pressure control. Therapeutic inertia, where medication is not intensified despite uncontrolled blood pressure, contributes significantly to this problem.
2) Target organ damage from hypertension can include brain, heart, kidney, and eye damage, increasing risks of stroke, heart disease, and death.
3) Initial hypertension treatment typically involves a thiazide diuretic followed by an ACE inhibitor or ARB and calcium channel blocker. Lifestyle changes and frequent follow up are also important parts of management. Resistant hypertension may require up to 7 medications and evaluation for secondary causes.
LANDMARK TRIALS IN STABLE CAD
The document discusses various clinical trials related to cardiovascular diseases. It summarizes the ACCORD BP study which found that targeting a SBP of <120 mm Hg compared to <140 mm Hg in patients with type 2 diabetes did not reduce cardiovascular events. It also summarizes the HOPE trial which found that ramipril reduced cardiovascular deaths, myocardial infarction, and stroke in high-risk patients without low ejection fraction or heart failure. Finally, it summarizes the EUROPA trial which found that perindopril reduced the primary endpoint of cardiovascular mortality, non-fatal MI, and cardiac arrest in patients with stable coronary artery disease.
Cardiac Investigation In Heart Failure
This document summarizes guidelines for cardiac investigation and management of heart failure. It addresses:
- When to assess for coronary artery disease in heart failure patients
- Indications for endomyocardial biopsy and BNP testing
- Use of echocardiography and stress testing to evaluate patients
- Screening for rare diseases and comorbidities
- Use of cardiac resynchronization therapy and implantable cardioverter-defibrillators in heart failure
The document provides guidance on the appropriate use of diagnostic tests and treatments based on a patient's symptoms, ejection fraction, QRS duration, and response to medical therapy.
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Most common derm lesions ddx sx-to-dx stern
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Painful peripheral neuropathy
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Differential Diagnosis Generation
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- 3. Search
- 4. Source ASCOT Trial: CCB (Amlodipine) vs BB (Atenolol)
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- 7. 567 799 9072 8819 CV endpoints NOD 5.5 years Amlodipine Atenolol NOD (+) No NOD