Effect of Valsartan in early-stage sarcomeric hypertrophic cardiomyopathy
Sarcomeric hypertrophic cardiomyopathy raises the risk of HF, AF, and sudden death. VANISH trial tried to examine whether angiotensin II receptor blocker, Valsartan, could slow the development. It was found that treatment showed positive effects on cardiac structure and function.
Effect of Empagliflozin on Adverse Renal Outcomes in Chronic Heart Failure
Milton Packer presented the pooled analysis of EMPEROR-Reduced and EMPEROR-Preserved at the ESC Congress 2021. Both the trials showed that Empagliflozin reduced the risk of heart failure hospitalisation by 30% in patients with a reduced and preserved ejection fraction. The drug effect was similar across ejection fractions < 65%, with the drug effect attenuating at higher levels (65% or greater)
Effect of Empagliflozin on cardiovascular death and hospitalization in heart failure patients
EMPEROR-Preserved trial is the first trial to show unequivocal clinical benefits of Empagliflozin in patients with heart failure and a preserved ejection fraction. The trial demonstrated that Empagliflozin reduces the risk of a composite of cardiovascular death or hospitalisation for heart failure in patients with heart failure and a preserved ejection fraction with or without diabetes.
Do we need beta blockers in hypertension
BBs are less effective in reducing stroke compared to other drugs, while they are as equivalent as other drugs in preventing major CV events. BBs have shown to be particularly useful in treatment of hypertension in specific situations: Symptomatic angina; Heart rate control; Post myocardial infarction; HFrEF; Younger hypertensive women planning pregnancy or a childbearing potential.
Sympathetic nervous system: Key regulator of multiple targets
SNS regulates cardiovascular and metabolic functions. Autonomic dysfunction is linked to HTN, BP variability, heart rate, blood flow and HRV. The various ways to modify vago-sympathetic activity and favourably change in BP and metabolic profile are: Lifestyle and weight loss; CPAP; New glucose-lowering drugs; Renal denervation; Central Sympatholytic agents - targeting BP and insulin resistance.
Association of COVID-19, hypertensive hospitalized patients with mortality
The cross-sectional, observational, retrospective multicentre study states that hypertension is considered to be an independent risk factor for all-cause mortality in COVID-19 patients. HTN was found to be significantly predictive of all-cause mortality with multivariate analysis results and the analysis adjusted for gender, age, and Charlson Comorbidity Index scores.
ISH hypertension guidelines: Secondary and Resistant Hypertension
Essential Secondary HTN can be screened through history+clinical clues+basic blood biochemistry + dipstick urine analysis. Optimal Secondary HTN can be screened through additional biochemistry tests or imaging based on information from history, physical examination and basic clinical investigations and/or if feasible, it is advised to refer to a specialist centre.
ISH hypertension guidelines: Essential treatment standards
BP may rise even after lifestyle modifications in patients with hypertension. The risk may be high in patients with Grade I hypertension, 140-159/90-99 mmHg. In this case, treatment has to be initiated immediately. While in low risk patients, dietary and lifestyle changes can help control BP. If BP is still uncontrollable, patients can be rationed on drug treatment based on risk status.
ISH hypertension guidelines: Optimal standards for hypertension treatment
Following steps are recommended:1: Dual low dose combination of ACE inhibitor or ARB (A) and Dihydropyridine CCB (C).2: Dual full dose combination as monotherapy in low-risk Grade I HTN patients a combination of A+ Thiazide like diuretic (D) and a combination of C+D in black patients.3: A+C+D triplet combination.4: A triple combination with spironolactone or another drug.
ISH hypertension guidelines: Lifestyle modification
Healthy lifestyle choices can prevent or delay onset of high BP & can reduce CV risk and are recommended as 1st line of anti-hypertensive treatment. Dietary changes, reduced salt intake, drinking healthy drinks, avoiding obesity and engagement of regular moderate-intensity aerobic & resistance exercises for 30 mins for 5-7 days a week, and reducing stress can help manage hypertension.
Triple Single-Pill Combination: What do the guidelines tell us?
The recipe for successful treatment of a hypertensive patient is appropriate treatment, therapy adherence and inertia-free physician. Triple single-pill combination facilitates BP control in difficult to manage hypertension and provides optimal CV protection. Combination therapy leads to quicker BP control, less variability, safe and well-tolerated, and better adherence.
20 Years Follow up of ASCOT-LEGACY
The ASCOT-Legacy Study was conducted in the UK for 21 yrs and included 8580 hypertensive patients. Patients received either atenolol+/-diuretic or amlodipine+/-perindopril-based treatments. Patients on amlodipine-based treatment had reduced risk of atrial fibrillation, stroke, total coronary and CV events compared to those on atenolol-based treatment.
Treatment adherence & resistance in patients with hypertension.
Non-adherence is a common and an important contributor to Hypertension associated morbidity. Different people have different reason for non-adherence. Adherence can change over time as circumstances/beliefs/behaviors change so it becomes important to reassess regularly. Adherence in resistant patients should be the 1st point to be considered before treatment or investigations are initiated.
