This document summarizes guidelines for the treatment of hypertension from various medical organizations. It finds that reducing blood pressure reduces cardiovascular risks, and regimens based on ACE inhibitors such as perindopril have been shown to significantly improve survival in clinical trials. The guidelines recommend treating hypertension when systolic is over 150/90 for those over age 60, or over 140/90 for those under 60 with kidney disease or diabetes. Initial treatment should include ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics. The goal of treatment is to lower blood pressure to under 140/90 mmHg for most patients.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
http://www.theheart.org/web_slides/1425587.do
A randomized to placebo or ivabradine study on Systolic Heart Failure Treatment with the If Inhibitor Ivabradine (SHIFT) with patients on standard HF medications according to guidelines
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
http://www.theheart.org/web_slides/1425587.do
A randomized to placebo or ivabradine study on Systolic Heart Failure Treatment with the If Inhibitor Ivabradine (SHIFT) with patients on standard HF medications according to guidelines
1. A Case report of Heart Failure
2. Discussion on Heart Failure
3. Role of Peptides in Heart Failure
4. Importance of 30 days in heart failure
5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF)
6. Biomarkers in Heart Failure
7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study)
8. Role of ARNI in HFpEF (PARAMOUNT Trial)
9. Safety and usefulness of ACEI/ARB/ARNI
10. Role of SGPL2 inhibitors in HF with/without DM
ARBs (Angiotensin receptor blockers) are the most widely used anti hypertensive throughout the world. A solid knowledge related to ARB will make our practice more patients friendly & benefit will be maximum.
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Vymada Tablet (ARNI: Angiotensin Receptor Neprilysin Inhibitor) is an anti-hypertensive drug used in combination with Sacubitril & Valsartan to reduce the risk of cardiovascular events in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
Combination Therapy In Hypertension - Dr Vivek Baliga PresentationDr Vivek Baliga
Dr Vivek Baliga of Baliga Diagnostics, Bangalore, discusses the common combination therapies used in the management of hypertension in clinical practice.
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
1. A Case report of Heart Failure
2. Discussion on Heart Failure
3. Role of Peptides in Heart Failure
4. Importance of 30 days in heart failure
5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF)
6. Biomarkers in Heart Failure
7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study)
8. Role of ARNI in HFpEF (PARAMOUNT Trial)
9. Safety and usefulness of ACEI/ARB/ARNI
10. Role of SGPL2 inhibitors in HF with/without DM
ARBs (Angiotensin receptor blockers) are the most widely used anti hypertensive throughout the world. A solid knowledge related to ARB will make our practice more patients friendly & benefit will be maximum.
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Vymada Tablet (ARNI: Angiotensin Receptor Neprilysin Inhibitor) is an anti-hypertensive drug used in combination with Sacubitril & Valsartan to reduce the risk of cardiovascular events in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
Combination Therapy In Hypertension - Dr Vivek Baliga PresentationDr Vivek Baliga
Dr Vivek Baliga of Baliga Diagnostics, Bangalore, discusses the common combination therapies used in the management of hypertension in clinical practice.
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
This talk address the BP guidelines from world societies and also from Taiwan Society of Cardiology (TSOC). See the outline below:
TSOC 2010
ESH/ESC 2013
ASH/ISH 2013
JNC 8 2014
CHEP 2015
TSOC 2015
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
HYPERTENSION- THE LATEST MANAGEMENT
Dr. Awadhesh kumar sharma is a young, diligent and dynamic interventional cardiologist. He did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from MLB Medical college jhansi. Then he did his superspecilisation degree DM in Cardiology from PGIMER & DR Ram Manoher Lohia Hospital Delhi. He had excellent academic record with Gold medal in MBBS,MD and first class in DM.He was also awarded chief ministers medal in 2009 for his academic excellence by former chief minister of UP Smt Mayawati in 2009.He is also receiver of GEMS international award.He had many national & international publications.He is also in editorial board of international journal- Journal of clinical medicine & research(JCMR).He is also active member of reviewer board of many journals.He is also trainee fellow of American college of cardiology. He is currently working in NABH Approved Gracian Superspeciality Hospital Mohali as Consultant Cardiologist.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
2. Global Mortality 2000:
Hypertension is the major risk factor
7.6 million deaths
Developing regions
Developed regions
0
1
2
3
4
5
6
7
8
Attributable mortality in millions (total: 55 861 000)
Adapted from Ezzati et al. Lancet 2002;360:1347-1360.
3. Guidelines: a paradox?
Goals of treatment
“The primary goal of treatment of the hypertensive patient is to achieve
the maximum reduction in the long-term total risk of cardiovascular
morbidity and mortality.“
Therapeutic management of hypertension
“Antihypertensive treatment translates into significant reductions of
cardiovascular morbidity and mortality while having a less significant
effect on all cause mortality.”
European guidelines for the management of arterial hypertension. J Hypertens. 2007, 25:1105–1187
4. Relationship between BP reduction and
cardiovascular outcomes
Relative risk of outcome event
All-cause mortality
Systolic blood pressure difference between randomized groups (mm Hg)
BPLTT Collaboration. Lancet. 2003;362:1527-1535.
5. RAAS inhibitors are the cornerstone
of the antihypertensive treatment
CCB
31%
ACEi plain + comb
RAAS
inhibitors
47%
BB
12%
DIU
10%
ARB plain + comb
MS in prescriptions
Source: IMS. Medical Universe - MAT in prescriptions, 35 countries, 2009
Canada,
Republic,
Kingdom,
United
States,
Austria,
Finland, France, Germany, Greece, Hungary, Ireland, Italy, Netherlands, Poland,
Australia,
Egypt,
Indonesia,
Japan
(includes
hospital
data),
New
Zealand,
Belgium,
Portugal, Slovakia, Spain, Switzerland,
Pakistan,
Philippines,
Saudi
Arabia,
Czech
United
South
6. 2009 Reappraisal of 2007 European Guidelines:
recommended combinations
Diuretics
-blockers
Angiotensin
receptor blockers
Calcium channel
blockers
1-blockers
ACE inhibitors
Preferred combinations
Other possible combinations
J Hypertens. 2007;25:1105–1187.J Hypertens. 2009;27:2121-2158.
7. Reduction in mortality with
amlodipine/perindopril in ASCOT
Cardiovascular mortality
24%, p=0.001
11%, p=0.0247
%
%
10.0
3.5
3.0
atenolol/thiazide
atenolol/thiazide
(No. of events 820)
8.0
(No. of events 342)
2.5
6.0
2.0
4.0
1.5
1.0
amlodipine/perindopril
0.5
0.0
All-cause mortality
(No. of events 263)
0.0
1.0
3.0
2.0
Years
4.0
5.0
2.0
amlodipine/perindopril
(No. of events 738)
0.0
0.0
1.0
2.0
3.0
4.0
5.0
Years
Dahlof B, et al. Lancet. 2005;366:895-906.
8. Components of antihypertensive efficacy…
Prognostic value of blood pressure parameters
… have independent predictive value
3.5
Adjusted 5-year risk of CV death (%)
Nocturnal BP
3.0
24-hour BP
2.5
Daytime BP
2.0
1.5
Conventional
office BP
1.0
N=5292
0.5
90
110
130
150
170
190
210
230
Systolic BP (mm Hg)
Dolan E, et al. Hypertension. 2005;46:156-161.
9. 24 hour antihypertensive efficacy:
trough-to-peak ratio
perindopril
Acertil
Fosinopril
Lisinopril
Ramipril
Benazepril
Enalapril
Telmisartan
Losartan
Valsartan
Olmesartan
Irbesartan
0
10
20
30
40
50
60
70
80
90
100
T/P ratio (%)
1. Physicians Desk Reference. NJ: Medical Economics Company; 2008. 2. Diamant H and Vincent HH. Lisinopril versus enalapril: evaluation of
trough:peak ratio by ambulatory blood pressure monitoring. J Hum Hypertens. 1999;13:405-412. 3. Martell M, Gill B, Marin R, et al. Trough to peak ratio
of once-daily lisinoprol and twice-daily captopril in patients with essential hypertension. J Hum Hypertens. 1998;12:69-72. 4. Hermida RC, Calvo C, Ayala
DE, et al. Administration time-dependent effects of valsartan on ambulatory blood pressure in hypertensive subjects. Hypertension. 2000;42:282-290.
10. ASCOT: night-time SBP and DBP
Night-time SBP
145
140
135
Night-time DBP
Mean atenolol/thiazide = 125.2 mm Hg
Mean amlodipine/perindopril = 123.0 mm Hg
Mean difference (95% CI) = 2.2 (-3.4, -0.9) mm Hg
P=0.0008
SBP = –2.2 mm Hg
90
85
Mean atenolol/thiazide = 68.6 mm Hg
Mean amlodipine/perindopril = 69.4 mm Hg
Mean difference (95% CI) = 0.8 (0.0-1.6) mm Hg
P=0.0523
DBP = 0.8 mm Hg
80
130
75
125
70
120
65
1
2
3
4
Time (years)
5
1
2
3
4
Time (years)
5
PP = –1.4 mm Hg
amlodipine/perindopril
atenolol/thiazide
Dolan E, et al. J Hypertens 2009.
11. BP variability predicts cardiovascular events
better than does mean brachial systolic BP
Stroke
CHD
By decile of
mean SBP
By decile of
standard
deviation (SD)
in SBP
amlodipine/perindopril
atenolol/thiazide
Rothwell PM, et al. Lancet. 2010;375:895-905.
12. ASCOT: amlodipine/perindopril
lowers BP variability vs atenolol/thiazide
All patients
Mean within-visit CV SBP
4.5
atenolol/bendroflumethiazide
4.3
4.1
3.9
amlodipine/perindopril
3.7
3.5
Follow-up (years)
Baseline 6 W 3 Mths
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Rothwell PM, et al. Lancet Neurol. 2010;9:469-480.
13. Reduction of central pressure
Brachial systolic
pressure
Central systolic
pressure
mm Hg
mm Hg
0
Athenolol/thiazide
130
5
125
-10
-15
120
-20
115
-25
-30
Amalodipine/perindopril
110
NS
P<0.2
Amlodipine/perindopril
1
Atenolol/thiazide
2
3
4
Time (years)
5
6
Central pressure difference:
- 4.3 mm Hg (P<0.0001)
Williams B, et al. Circulation. 2006;113:1213-1225.
14. Conclusion
• Hypertension is a major risk factor for mortality worldwide
• Reduction in the mortality risk is the ultimate goal of the
antihypertensive treatment
• According to our analysis, regimens based on ACE inhibition, in
particular with perindopril, significantly improve survival in
hypertensive patients
• Benefits of perindopril in monotherapy or in combination with
amlodipine or indapamide are strongly supported by evidence from
large morbidity-mortality trials
(EUROPA, PROGRESS, ADVANCE, HYVET, ASCOT)
• This benefits might not be necessarily shared by other available
antihypertensive drugs and their combinations
15. ASH(American Society of Hypertension) and
ISH(International Society of Hypertension
Age 80 or more-------- >150/90
CKD and DM----------- <140/90
Age<60-------------------ACEI or ARB(non black)
Age >60------------------CCB or Thiazide(non black)
AHA/ACC/CDC
Stage 1 H/T--------systolic (140-159 or diastolic(90-99)
Stage 2 H/T--------systolic (>160
or diastolic >100
Recommended----combination of thiazide diuretic and ACEI,ARB or CCB
Goal not achieved---increase the dose and or add drug from different class
16. New European Hypertension Guidelines Released: Goal
Is Less Than 140 mm Hg for All(ESH and ESC)
High-normal------systolic (130 to 139 diastolic (85 to 89)
Grade 1 H/T--------systolic (140-159 or diastolic(90-99)
Grade 2 H/T--------systolic (160-179
or diastolic 100-109)
Grade 3 H/T---------systolic (>180
or diastolic >110)
Life style-----salt <5 to 6 gram/day)
BMI-------------25
Target organ damage/disease
CVD risk
Target
<140 mmHg systolic in age <80
<150 mmHg systolic in age >80
DM
diastolic <85 mmHg
18. New Targets
Treat hypertension >150/90 or higher in
Target---Below this level
age>60 or older
Treat hypertension >140/90 or higher in
CKD or DM regardless of age
age<60 ----30 or patients with
Initial choice of treatment
• For non black including DM-----ACEI/ARB/CCB/Thiazide
diuretic-------first line therapy
• For black including DM------------CCB and Thiazide (first
line)
• CKD regardless of DM------------ACEI or ARB initial or add
on therapy to improve renal outcome