This study used data from over 21,000 patients in Japan to analyze the relationship between blood pressure measurements and cardiovascular outcomes. It found that morning home systolic blood pressure was a stronger predictor of coronary artery disease events than clinic systolic blood pressure. Morning home systolic blood pressure of 125 mmHg or higher was associated with higher risk of coronary events. Both home and clinic blood pressures effectively predicted risk of stroke. The study demonstrated that for this population, morning home systolic blood pressure monitoring provided valuable information about cardiovascular disease risk.
Intensive Glucose Control in Patients with Type 2 Diabetes — 15-Year Follow-upMohammed Shadman Shakib
VADT 15 year follow up NEJM article presentation
NEJM
June 6,2019
380:2215-2224
This article was presented in the morning session of MU-II, Dhaka Medical College Hospital.
Effects of aspirin for primary prevention in persons with Diabetes mellitusShadab Ahmad
The ASCEND(A Study od Cardiovascular Events in Diabetes) randomized trial was performed to assess the efficacy and safety of enteric-coated aspirin at a dose of 100 mg daily, as compared with placebo, in person who had diabetes without manifest cardiovascular disease.
Naturopathic Treatmentfor the Prevention ofCardiovascular Disease: A Randomized Pragmatic TrialCCNM – Journal Club Sept 30th, 2010Dugald Seely, ND, MScDirector; Research & Clinical EpidemiologyThe Canadian College of Naturopathic Medicine
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Jeremy Chow
Cardiologist, Electrophysiologist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Goal attainments and their discrepancies for low density lipoprotein choleste...Paul Schoenhagen
Purpose: Low density lipoprotein cholesterol (LDL-C) is primary treatment target for patients with dislipidemia. The apolipoprotein B (apo B), an emerging biomarker for cardiovascular risk prediction, appears to be superior to the LDL-C. However, little is known about goal attainments and their discrepancies for LDL-C and apo B in Chinese patients with known CAD or DM.
Intensive Glucose Control in Patients with Type 2 Diabetes — 15-Year Follow-upMohammed Shadman Shakib
VADT 15 year follow up NEJM article presentation
NEJM
June 6,2019
380:2215-2224
This article was presented in the morning session of MU-II, Dhaka Medical College Hospital.
Effects of aspirin for primary prevention in persons with Diabetes mellitusShadab Ahmad
The ASCEND(A Study od Cardiovascular Events in Diabetes) randomized trial was performed to assess the efficacy and safety of enteric-coated aspirin at a dose of 100 mg daily, as compared with placebo, in person who had diabetes without manifest cardiovascular disease.
Naturopathic Treatmentfor the Prevention ofCardiovascular Disease: A Randomized Pragmatic TrialCCNM – Journal Club Sept 30th, 2010Dugald Seely, ND, MScDirector; Research & Clinical EpidemiologyThe Canadian College of Naturopathic Medicine
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Jeremy Chow
Cardiologist, Electrophysiologist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Goal attainments and their discrepancies for low density lipoprotein choleste...Paul Schoenhagen
Purpose: Low density lipoprotein cholesterol (LDL-C) is primary treatment target for patients with dislipidemia. The apolipoprotein B (apo B), an emerging biomarker for cardiovascular risk prediction, appears to be superior to the LDL-C. However, little is known about goal attainments and their discrepancies for LDL-C and apo B in Chinese patients with known CAD or DM.
Q-1The disease process I chose for this article is the treatment.docxwoodruffeloisa
Q-1
The disease process I chose for this article is the treatment of chronic hypertension and the medication I chose was Amlodipine (Norvasc).
Hypertension is on the rise in the world and becoming one of the highest occurring disease processes according to the World Health Organization (Lee et al., 2019). The age group with the largest rate of occurrence is patients ages 65 and older at a prevalence rate of 67% (Lee et al., 2019). Amlodipine (Norvasc) is a calcium channel blocker and has a longer half life with a slower onset when compared to other generations of calcium channel blockers (Lee et al., 2019).
The mechanism of action for Norvasc is that it inhibits the movement of calcium ions into the vascular smooth muscle cells and cardiac muscle cells to prevent the constriction of the cardiac muscle and vascular smooth muscle (Lee et al., 2019). This prevention of contraction keeps the vessels “wide” in order to allow easy flow of blood and to decrease blood pressure by decreasing peripheral vascular resistance (Lee et al., 2019). Oral administration
Some common adverse effects of Norvasc are due to the vasodilatation of the blood vessels (Hong et al., 2019). They include peripheral edema, dizziness, palpiations, fatigue, nausea, abdominal pain, somnolence, and flushing (Hong et al., 2019). Rare side effects include blood disorders, impotence, depression, peripheral neuropathy, insomnia, tachycardia, gingival enlargement, hepatitis, and jaundice (Hong et al., 2019).
There are several drugs that have an interaction with Norvasc (Hong et al., 2019). Mainly any drug that influences the level or efficiency of CYP3A inhibitors will also cause an increase of bioavailability of Norvasc in the body (Hong et al., 2019). Some other interactions occur when the patient is also taking cardizem, clarithromycin, and some antifungal (Hong et al., 2019). These interactions with drugs also increase the bioavailability of Norvasc in the body (Hong et al., 2019).
There was a time where a patient came into the ER with a hypertensive emergency and this patient was taking beta-blockers and an ARB. When this patient came to the ICU we started him on cardine for a B/P of 195/103. As we started to bring his pressure out of stroke range, they physician then started Norvasc at 5mg p.o. daily. We did give him his first dose, and noticed a further drop in blood pressure down to a normal range. We then titrated the patient off cardine and were able to keep him off with the new combination of anti-hypertensives and the fact that we were addressing three of the four ways to control hypertension.
References:
Hong, S. J., Jeong, H. S., Cho, J.-M., Chang, K., Pyun, W. B., Ahn, Y., … Kim, H.-S. (2019). Efficacy and Safety of Triple Therapy With Telmisartan, Amlodipine, and Rosuvastatin in Patients With Dyslipidemia and Hypertension: The Jeil Telmisartan, Amlodipine, and Rosuvastatin Randomized Clinical Trial. Clinical Therapeutics, 41(2), 233–248. https://doi-org.lopes.idm.ocl ...
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
16. HOPE 3HOPE 3
COMBINATION OF STATINS ANDCOMBINATION OF STATINS AND
ANTIHYPERTENSIVESANTIHYPERTENSIVES
This article was published on April 2, 2016,
at NEJM.org.
DOI: 10.1056/NEJMoa1600177
18. Both systolic blood pressure and low density lipoprotein
(LDL) cholesterol show graded associations with
cardiovascular disease.
Account for two thirds of the population-attributable risk
of cardiovascular disease.
19. Combined lowering of LDL cholesterol and blood pressure
can potentially have a bigger effect in reducing
cardiovascular events than either intervention alone.
Majority of cardiovascular events occur in persons at
average risk with no previous cardiovascular disease.
Strategy of broad population-based treatment of LDL
cholesterol and blood pressure could be more effective
than targeting only high-risk persons.
20. These considerations form the basis for theThese considerations form the basis for the
polypill concept, which theorizes largepolypill concept, which theorizes large
reductions in cardiovascular events withreductions in cardiovascular events with
systematic use of combination-drug therapysystematic use of combination-drug therapy
in middle-aged and older persons in thein middle-aged and older persons in the
general population.6,7general population.6,7
6. Wald NJ, Law MR. A strategy to reduce cardiovascular
disease by more than 80%. BMJ 2003;3 26:1 419.
7. Yusuf S. Two decades of progress in preventing vascular
disease. Lancet 2002; 360:2 -3.
21. Investigators evaluated the effects of a MODERATE
DOSE OF A POTENT STATIN VS PLACEBO,
A FIXED COMBINATION OF MODERATE DOSES
OF AN ARB DIURETIC VS PLACEBO,
and THE COMBINATION OF BOTH TREATMENTS
VS DUAL PLACEBO on the prevention of major
cardiovascular events.
23. TRIAL DESIGN AND OVERSIGHT
The HEART OUTCOMES PREVENTION
EVALUATION (HOPE)–3 trial is a multicenter, long-
term, international,double-blind, randomized, placebo-
controlled trial with a 2-by-2 factorial design among
persons who did not have cardiovascular disease and who
were at intermediate risk (defined as an annual risk of
major cardiovascular events of approximately 1%).
Conducted at 228 centers in 21 countries.
31. TRIAL PROCEDURES
Eligible persons entered a single-blind run-in phase, during
which they received both active treatments for 4 weeks.
Participants who adhered to the regimen and who did not
have an unacceptable level of adverse events were
randomly assigned to a fixed combination of
CANDESARTAN (16 mg per day) and
HYDROCHLOROTHIAZIDE(12.5 mg per day) or
placebo and to ROSUVASTATIN(10 mg per day) or
placebo.
32. Follow-up visits occurred at 6 weeks and 6 months after
randomization and every 6 months thereafter.
Blood pressure was recorded at each visit in the first year
and then annually.
Lipid levels were measured at baseline in all participants
and at 1 year, at 3 years, and at the end of the trial.
33.
34. A total of 12,705 participants who adhered toA total of 12,705 participants who adhered to
the regimen and did not have an unacceptablethe regimen and did not have an unacceptable
level of adverse events during the run-in periodlevel of adverse events during the run-in period
underwent randomization. Of these,underwent randomization. Of these,
3180 were assigned to (combined therapy),3180 were assigned to (combined therapy),
3181 to rosuvastatin plus placebo,3181 to rosuvastatin plus placebo,
3176 to candesartan hydrochlorothiazide plus3176 to candesartan hydrochlorothiazide plus
placebo,placebo,
3168 to placebo plus placebo3168 to placebo plus placebo
35.
36. OUTCOMES
There were two coprimary outcomes:
1)the composite of death from cardiovascular causes, nonfatal
myocardial infarction,or nonfatal stroke.
2)the composite of these events plus resuscitated cardiac
arrest, heart failure, or revascularization.
The secondary outcome was the composite of events
comprising the second coprimary outcome plus angina
with evidence of ischemia.
44. BLOOD PRESSURE AND LIPID
LEVELS
On average , the mean SBP was lower by 6.2 mm Hg in
the combined-therapy group than in the dual placebo
group, the mean DBP was lower by 3.2 mm Hg, and the
mean LDL cholesterol level was lower by 33.7 mg per
deciliter .
The difference in blood pressure was similar for
participants assigned to candesartan– hydrochlorothiazide
alone versus placebo.
The difference in LDL cholesterol level was similar for
participants assigned to rosuvastatin alone versus placebo.
50. DISCUSSION
In the HOPE-3 trial, which involved a primary prevention
population at intermediate risk and with average lipid and
blood pressure levels,combination therapy with
rosuvastatin (10 mg per day), candesartan (16 mg per day),
and hydrochlorothiazide(12.5 mg per day) for a median of
5.6 years was associated with a significantly lower risk of
cardiovascular events than dual placebo (29% lower
relative risk and 1.4-percentage-point lower absolute risk
of the first primary outcome).
51. The number needed to treat for 5.6 years to prevent one
event of the first coprimary outcome was 72.
The number needed to treat to prevent one event of the
second coprimary outcome was 63.
In post hoc recurrent-events analysis, the benefit was
slightly larger.
52. The reduction in LDL cholesterol concentration was
approx. 33.7 mg per dl over the course of the trial and the
reduction in SBP was 6.2 mm Hg.
Rates of adherence to drugs were high, and so the degree
of cholesterol and blood-pressure lowering , in a large
population treated over a median of 5.6 years, is probably
more representative than that observed in small, short-term
trials involving persons with elevated blood pressure or
high lipid levels.
53. Post hoc subgroup analysis was performed comparing
participants in the upper third of baseline SBP with those
in the lower two thirds.
In the upper third, the risk of the two coprimary
outcomes was approx.40% lower with combined therapy
than with dual placebo, whereas the relative risk was
only about 20% lower among participants with lower
SBP.
54. The effects of rosuvastatin in the HOPE-3 trial were
independent of blood-pressure or lipid levels.
These different lines of evidence suggest that
combination therapy (with a statin and blood-pressure-
lowering treatment) would perform best in persons with
elevated blood pressure, whereas statins alone would
perform best in those without elevated blood pressure.
55. No significant differences between the combined-therapy
group and the dual placebo group were seen in the rate of
new-onset diabetes, renal dysfunction, syncope, liver-
function abnormalities,eye problems, or cancers.
The rates of muscle weakness or pain and of dizziness
were higher in the combined-therapy group than in the
dual-placebo group.
These effects were reversible by temporary discontinuation
of the trial drug.
56. Investigators approach of selecting persons on the basis of
age and easily measured risk factors meant that neither
complex screening nor blood tests are required to initiate
treatment with low doses of combination therapy.
Trial included persons of diverse racial and ethnic groups
from 21 countries with broadly consistent benefits and
safety.
57. CONCLUSION
Treatment with fixed doses of rosuvastatin and two
antihypertensive agents was associated with a significantly
lower risk of cardiovascular events than the risk with
placebo among intermediate-risk persons without previous
cardiovascular disease.
62. Many studies have shown that clinic blood pressure (CBP)
is a useful predictor of cardiovascular events, such as
stroke and coronary artery disease (CAD).
But in some of these studies, the relationship between CBP
and stroke events and between CBP and CAD events was
investigated separately.
The results showed that although CBP is a strong predictor
of stroke events, it might not be effective in predicting
CAD events.
63. The relationship between out-of-office blood pressure
(BP), such as ambulatory BP and home blood pressure
(HBP), and cardiovascular events has been investigated in
several studies but there is insufficient evidence as yet
regarding which BP measurement predicts CAD events
most strongly.
64. Among out-of-office BP measurements, HBP has the
advantage of being easy to measure, allowing multiple
measurements and long-term monitoring.
However, it remains unclear as to which time of day
HBP should be measured to predict CAD events
effectively.
Investigators found that morning hypertension predicts
cardiovascular events because both incidence of
cardiovascular events and BP peak in the early morning.
65. In theIn the HONEST (Home blood pressure measurement
with Olmesartan Naïve patients to Establish Standard
Target blood pressure)study , authors investigated the
relationship between morning HBP and the incidence of
CAD events and stroke events using data from the largest
real-world prospective study.
67. PATIENTS
Olmesartan-naive outpatients with a diagnosis of essential
hypertension,who already owned a validated and approved
electronic device for measuring HBP using the cuff-
oscillometric principle, and who had recorded their
morning HBP on 2 of the 28 days before starting
olmesartan therapy, were eligible to participate.
No BP range was specified as a criterion for eligibility.
Patients were registered after being prescribed olmesartan
in the period between October 1, 2009 and September 30,
2010.
68. BP TARGETS AND ANTIHYPERTENSIVE
DRUG THERAPY.
BP targets and olmesartan dose (administered orally,
generally 10 or 20 mg once daily) were at the discretion of
individual physicians.
Prior olmesartan therapy was an exclusion criterion.
No restrictions were placed on the use of combination
antihypertensive drug therapy during the study period.
69. HBP MEASUREMENT.
Patients were asked to measure their HBP twice in the
morning and twice at bedtime on 2 different days for
each measurement point.
During the follow-up period, HBP was measured at 1, 4,
and 16 weeks, and at 6, 12, 18, and 24 months.
The average of the 2 HBP measurements at each time was
calculated.
For each measurement point, authors used the average
HBP over 2 days.
Average HBP measurements during follow-up, were used
in the analysis of their relationship with incidence of
stroke and CAD events.
70. CBP MEASUREMENT
CBP was measured according to the usual methods of each
institution.
During the follow-up period, CBP was measured at 4 and
16 weeks, and at 6, 12, 18, and 24months.
For each measurement point, 1 measurement was reported.
Average CBP measurements during follow-up, excluding
baseline values, were used in the analysis.
71. EVALUATION OF STROKE AND CAD
EVENTS.
All ischemic and hemorrhagic cerebrovascular events,
except for transient ischemic attacks, were defined as
stroke events.
Myocardial infarction and angina pectoris with coronary
revascularization procedure were defined as CAD events.
73. Data from 21,591 participants were included in the
analysis.
The mean follow-up period was 2.02 ± 0.50 years.
10,921 (51%) were women, and the mean age was 64.9 ±
11.9 years.
78. There does not appear to be a J-curve phenomenon in the
relationship between morning HBP and stroke or CAD
events.
STROKE
CAD
79. DISCUSSION
HONEST study, which included >20,000 Japanese
hypertensive patients,shows that morning HBP is a strong
predictor of future CAD events, as well as stroke events,
and may be superior to CBP.
The analysis also showed that there does not appear to be
a J-curve in the relationship between morning HBP and
stroke or CAD events.
The relationship between HBP, compared with CBP, and
cardiovascular events has been investigated in several
studies ,but few studies have investigated the relationship
between HBP and CAD events.
80. RELATIONSHIP BETWEEN HSBP AND STROKE
EVENTS.
This analysis of data from the HONEST study has shown
that morning and evening HSBP,like CSBP, are strong
predictors for stroke.
The incidence of stroke events was 2.92 per 1,000 patient-
years, similar to that found in previous studies, like
HOMED-BP and J-HEALTH.
81. RELATIONSHIP BETWEEN HSBP AND CAD
EVENTS
Analysis showed that morning HBP is a strong predictor of
future CAD events and may be superior to CBP or evening
HBP.
The incidence of CAD events was significantly higher in
patients with morning HSBP ≥145 mm Hg than in
those with morning HSBP <125 mm Hg.
However, for CSBP, the incidence of CAD events was
higher only in patients with CSBP ≥160 mm Hg
compared with <130 mm Hg.
82. Goodness-of-fit analysis
was conducted.
The model for stroke
events was similar
between morning HSBP
and CSBP, indicating that
both are important factors
in the prediction of stroke
events.
In contrast, CSBP was
significantly, but more
weakly associated with
CAD events than morning
HSBP.
83. Present study is the first to show that morning HSBP may
be superior to CSBP for the prediction of CAD events.
CAD events occur most frequently in the morning as there
is an increase in BP and BP variability in the morning,
resulting from:
A) increased activity of the renin-angiotensin system.
B) increased platelet function activity.
C)a thrombotic tendency at this time of the day.
84. HOME DBP
The relationship between morning HDBP or CDBP and
CAD events was investigated in study.
Both morning HDBP and CDBP may underestimate the
risk of CAD events compared with morning HSBP or
CSBP..
85. CONCLUSIONS
Morning HBP is a strong predictor of future CAD
events, as well as stroke events, and may be superior to
CBP in this regard.
Furthermore, there does not appear to be a J-curve in the
relationship between morning HBP and stroke or CAD
events.