This document discusses the role of ACE inhibitors (ACEIs) and calcium channel blockers (CCBs) in combination for optimizing hypertension treatment in patients with diabetes, chronic kidney disease, or left ventricular hypertrophy. It highlights that combination therapy is often required to achieve blood pressure goals in diabetic hypertension patients. The combinations of ACEIs or ARBs with CCBs provide renoprotective benefits in type 2 diabetes patients and treatment should be initiated early for those with high-normal blood pressure. The document emphasizes that even small reductions in blood pressure of 2 mmHg can lower cardiovascular risk by up to 10% according to various studies and guidelines.
Management of Hypertension and Diabetes in Aging People 2014Nemencio Jr
This module discusses the issues in the management and treatment goals for hypertension and diabetes in the older population based on the most recent guidelines
Nutritional therapy in hypertension and diabetes by SYED SHOAIB HUSSAINPARUL UNIVERSITY
hypertension and diabetes are common problems associated with improper diet habits, so diet therapy is a core management strategy to manage diabetes and hypertension
DIABETES AND CARDIOVASCULAR DISEASE - THE CONTINUUMPraveen Nagula
DIABETES IS ONE OF THE MOST COMMON NONCOMMUNICABLE DISEASES WORLD WIDE.
EVERY 6 SECONDS ONE PERSON IS AFFECTED BY DIABETES..
THEME FOR 2014-2016
LETS UNITE FOR DIABETES
Management of Hypertension and Diabetes in Aging People 2014Nemencio Jr
This module discusses the issues in the management and treatment goals for hypertension and diabetes in the older population based on the most recent guidelines
Nutritional therapy in hypertension and diabetes by SYED SHOAIB HUSSAINPARUL UNIVERSITY
hypertension and diabetes are common problems associated with improper diet habits, so diet therapy is a core management strategy to manage diabetes and hypertension
DIABETES AND CARDIOVASCULAR DISEASE - THE CONTINUUMPraveen Nagula
DIABETES IS ONE OF THE MOST COMMON NONCOMMUNICABLE DISEASES WORLD WIDE.
EVERY 6 SECONDS ONE PERSON IS AFFECTED BY DIABETES..
THEME FOR 2014-2016
LETS UNITE FOR DIABETES
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.
Several distinct types of DM are caused by a complex interaction of genetics and environmental factors.
Depending on the etiology of the DM, factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production.
The metabolic dysregulation associated with DM causes secondary pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health care system.
Hypertension is a silent, invisible killer that rarely causes symptoms. Increasing public awareness is key, as is access .Raised blood pressure is a warning sign that significant lifestyle changes are urgently needed. People need to know why raised blood pressure is dangerous, and how to take steps to control it.
Cardiovascular disease in diabetes mellitusYung-Tsai Chu
Reference: 2018 ADA guideline. Topics: hypertension management(drug choice and combination), indications for hyperlipidemia treatment, atherosclerosis disease prevention with antiplatelet agents and issues about coronary artery diseases.
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.
Several distinct types of DM are caused by a complex interaction of genetics and environmental factors.
Depending on the etiology of the DM, factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production.
The metabolic dysregulation associated with DM causes secondary pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health care system.
Hypertension is a silent, invisible killer that rarely causes symptoms. Increasing public awareness is key, as is access .Raised blood pressure is a warning sign that significant lifestyle changes are urgently needed. People need to know why raised blood pressure is dangerous, and how to take steps to control it.
Cardiovascular disease in diabetes mellitusYung-Tsai Chu
Reference: 2018 ADA guideline. Topics: hypertension management(drug choice and combination), indications for hyperlipidemia treatment, atherosclerosis disease prevention with antiplatelet agents and issues about coronary artery diseases.
Management of coronary disease in diabetes - Is it different?Dr Vivek Baliga
The management of diabetes and coronary artery disease go hand in hand. This presentation by Dr Vivek talks on whether it varies from usual management.
The TravelGuru, a member of BuzzFeed Community, recently compiled a list of the The 20 Most Beautiful Countries In The World. The list features destinations from all over the globe including: Chile, India, Switzerland and Nepal. We have compiled this deck of the Top 10 Most Beautiful Countries according to Travel Guru.
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
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
Role of aci ccb in htn management
1. Role of ACEIs/CCBs
combinations
in
Optimizing HYPERTENSION TREATMENT
of DM/CKD/LVH patients
CARDIO-METABOLIC RISK REDUCTION
DR./ADEL ELNAGGAR
Endocrinologist
Dr.Erfan & Bagedo General Hospital
6. ?Prehypertension
● NOT a DISEASE category
–Should encourage lifestyle
modification as this group has an
increased risk of becoming
hypertensive
● NOT candidates for drug therapy
(unless compelling indications ie
DM etc goal <130/80)
7.
8.
9. INSULIN RESISTANCE
METABOLIC SYNDROME
&
ADULT OBESITY
Central obesity (waist circumference)
IGT or IFG
High lipid profile
LDL-HDL/CHOLESTEROL/TRIGLYCERIDES
HIGH BP more than 130/90
11. Blood Pressure Reductions as Little as 2 mmHg
Reduce the Risk of Cardiovascular Events by up to
10%
Meta-analysis of 61 prospective, observational studies conducted by
Lewington et al involving one million adults with no previous vascular disease
at baseline.
2 mmHg decrease
in mean SBP
10% reduction in
risk of stroke
mortality
7% reduction in
risk of IHD
mortality
Lewington S, et al. Lancet. 2002;360:1903–1913
12. Every 1% reduction in HbA1c
can reduce long-term
DIABETES COMPLICATIONS1
*p<0.0001
1. Adapted from Stratton IM et al. BMJ 2000;321:405–412.
37%
21%
14%
Microvascular
complications*
Deaths related
to diabetes*
Myocardial
infarction*
13. Benefits of weight neutral/reduction
regimens in management of
type 2 diabetes
1. Anderson and Konz. Obes Res 2001;9(Suppl. 4):326S–334S
2. Anderson et al. J Am Coll Nutr 2003;22:331–9
BP, blood pressure; CV, cardiovascular; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-
density lipoprotein cholesterol; TC, total cholesterol; TG, triglycerides
14.
15.
16. Attributable mortality in millions (total: 55,861,000)
Developing region
Developed region
0 87654321
Adapted from Ezzati et al. Lancet 2002;360:1347–60
Global Mortality year 2000
Impact of Hypertension and Other Health Risk Factors
17. CV Mortality Risk Doubles with Each
20/10 mm Hg BP Increment*
CV
mortality
risk
SBP/DBP (mm Hg)
0
1
2
3
4
5
6
7
8
115/75 135/85 155/95 175/105
*Individuals aged 40-70 years, starting at BP 115/75 mm Hg.
CV, cardiovascular; SBP, systolic blood pressure;
DBP, diastolic blood pressure
Lewington S et al. Lancet 2002; 60:1903-1913. JNC 7. JAMA. 2003;289:2560-2572
22. Barriers to hypertension Care
Clinical Practice
Therapeutic Regimen
(poly-pharmacy/complex)
Disease Process
Patient Adherence
23.
24.
25. Medical Education & Information – for all Media, all Disciplines, from all over the World
Powered by
2013 ESH/ESC Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
Definitions and classification of office BP levels (mmHg)*
Category Systolic Diastolic
Optimal <120 and <80
Normal 120–129 and/or 80–84
High normal 130–139 and/or 85–89
Grade 1 hypertension 140–159 and/or 90–99
Grade 2 hypertension 160–179 and/or 100–109
Grade 3 hypertension ≥180 and/or ≥110
Isolated systolic hypertension ≥140 and <90
* The blood pressure (BP) category is defined by the highest level of BP, whether systolic or diastolic. Isolated systolic
hypertension should be graded 1, 2, or 3 according to systolic BP values in the ranges indicated.
Hypertension:
SBP >140 mmHg ± DBP >90 mmHg
26.
27. Diabetic hypertension
ESH/ESC guidelines
• To reach diabetic hypertension goals, combination
therapy is most often required
• Evidence indicates that combinations including an
ACE inhibitors or ARBs in Type 2 diabetes provide
Reno_protection benefits
• In patients with type 2 diabetes, treatment should
be initiated when BP is high-normal
ESH/ESC Guidelines. J Hypertens 2007;25:1105 -1187
32. ESHESC 2013 guidelines:
recommendations for BP goals1
A SBP goal <140 mmHg:
a) is recommended in patients at low–moderate CV risk;
b) is recommended in patients with diabetes;
c) should be considered in patients with previous stroke or TIA;
d) should be considered in patients with CHD;
e) should be considered in patients with diabetic or non-diabetic CKD
CHD: coronary heart disease; CKD : chronic kidney disease: CV: cardiovascular;
DBP: diastolic blood pressure; SBP: systolic blood pressure; TIA: transient ischaemic attack;
ESH: European Society of Hypertension; ESC: European Society of Cardiology
1Mancia et al. Eur Heart J 2013;34:2159–219
33. From: 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the
Panel Members Appointed to the Eighth Joint National Committee (JNC 8)
Comparison of Treatment Goals between Guidelines
34.
35.
36.
37. Medical Education & Information – for all Media, all Disciplines, from all over the World
Powered by
2013 ESH/ESC Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
Lifestyle changes for hypertensive patients
* Unless contraindicated. BMI, body mass index.
Recommendations to reduce BP and/or CV risk factors
Salt intake Restrict 5-6 g/day
Moderate alcohol intake Limit to 20-30 g/day men,
10-20 g/day women
Increase vegetable, fruit, low-fat dairy intake
BMI goal 25 kg/m2
Waist circumference goal Men: <102 cm (40 in.)*
Women: <88 cm (34 in.)*
Exercise goals ≥30 min/day, 5-7 days/week
(moderate, dynamic
exercise)
Quit smoking
44. Corrao et al. J Hypertens. 2011;29:610-618.
Coronary events
Cerebrovascular events
Hazardratioreduction(%)†
Very low
(reference)
–24% –23
Intermediate
–16%
–21%
Low
–10
0
–20
–30
–40
–50
–37% –36%
Persistence category
Continuing use
†Estimates are adjusted for gender, age, initial antihypertensive regimen,
number of different classes of antihypertensive medications dispensed during
follow-up, use of other drugs during follow-up, and categories of Charlson
comorbidity index score.
* At least 1 episode of no prescription coverage for > 90 days.
Adherence level
Discontinuing use*
(reference)
High
Effect of compliance with antihypertensive medications
on the risk of cardiovascular outcomes
44
45. Evolution of guidelines on fixed-dose
combinations
“The use of fixed-dose combinations may be advantageous…”
“Where they are no more expensive, such formulations may be preferable since they
have advantages in terms of compliance”
“When BP is more than 20/10 mm Hg above goal, consideration should be given to
initiating therapy with two drugs, either in separate prescriptions or in fixed-dose
combinations”
Fixed-dose combinations… allow administration of two agents within a single tablet,
thus optimizing compliance”
“Fixed-dose combinations reduce the number of tablets to be taken, and this has some
advantages on compliance”
“Whenever possible, use of single-tablet combinations should be preferred, because
simplification of treatment causes advantages for compliance to treatment”
“The guidelines favor the use of combinations of two antihypertensive drugs at fixed
doses in a single tablet, because… improves adherence… and increases the rate of
BP control”
1999 WHO/ISH
2003 WHO/ISH
2003 JNC 7
2003 ESH/ESC
2007 ESH/ESC
2009 ESH/ESC
2013 ESH/ESC
45
51. Difference between ACE inhibitors and ARBs
on mortality reductions in recent meta-analyses
51
1. van Vark LC, et al. Eur Heart J. 2012;33(16):2088-2097. 2. Lv J, et al. Cochrane Database Syst Rev. 2012;12:CD004136. 3. Baker WL, et al. Ann
Intern Med. 2009;151(12):861-871. 4. Savarese G, et al. J Am Coll Cardiol.15;61(2):131-142. 5. Hara et al. Am J Cardiol. 2014;114(1):1-8
52. ACEi plus CCB
Synergy at the clinical level
Less edema!!
Meta analysis:
25 trials
17,206 pts
CCB+ACEi: 54% less edema
CCB+ARB: 21% less edema
Makani H, et al. Am J Med 2011
53.
54. 55
Amlodipine/perindopril:
Beyond brachial blood pressure control
Williams et al.
Circulation.
2006;113(9):1213-1225
O’Brien et al.
J Hypertens.
2009;27(4):876-885.
Dahlöf et al.
Lancet.
2005;366(9489):895-906.
Rothwell et al.
Lancet Neurol.
2010;9(5):469-480.
55. More effective reduction in blood pressure
variability with amlodipine/perindopril
Watson et al. J Hypertens. 2014;32(e-suppl 1):e125.9C.06.56
Visit-to-visit variability of systolic blood pressure (SBP) in ASCOT-BPLA patients treated exclusively with either
amlodipine/perindopril or β-blocker/thiazide for at least 6 months.
Difference in baseline SBP (mm Hg, 95% CI) = -1.6 (-2.7 to -0.0056)
Difference in final SBP (mm Hg, 95% CI) = -0.6 (-1.6 to 0.4), P=0.2216
n=1 372 n=2 319