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Latest & greatest articles for hypertension
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Epoprostenol for pulmonary arterial hypertension 1 Driving better decision-making in healthcare Epoprostenol for treating pulmonary arterial hypertension Technology Guidance from the MOH Drug Advisory Committee Published on 1 April 2020 Guidance recommendations The Ministry of Health’s Drug Advisory Committee has recommended: ? ? epoprostenol (Veletri) 1.5 mg powder for solution for infusion for treating idiopathic or heritable pulmonary arterial hypertension (PAH) or PAH associated (...) Committee (“the Committee”) considered the evidence presented for the technology evaluation of epoprostenol (Veletri) for pulmonary arterial hypertension (PAH). The Agency for Care Effectiveness conducted the evaluation in consultation with clinical experts from public healthcare institutions. Published clinical and economic evidence for epoprostenol was considered in line with its registered indication. The Committee acknowledged that another brand of epoprostenol (Flolan) is available in Singapore
(treprostinil) An overview of Trepulmix and why it is authorised in the EU What is Trepulmix and what is it used for? Trepulmix is a medicine for use in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH), a condition linked with highbloodpressure in the lungs caused by blood clots. It can be used to improve the capacity for physical activity in patients: • who cannot have an operation for treating the condition; • whose condition remains or continues to return after an operation (...) that widens blood vessels and stops platelets (blood components) from sticking to each other to form blood clots. In patients with CTEPH, these effects of treprostinil prevent blood clots and lower bloodpressure in the pulmonary artery and so improve symptoms of the disease. What benefits of Trepulmix have been shown in studies? A main study involving 105 patients with severe CTEPH who could not have an operation found that Trepulmix can improve patients’ capacity for physical activity, measured
-selective NSAID plus a proton pump inhibitor (PPI), or a selective cyclo-oxygenase-2 (COX-2) inhibitor should be used; for those with a high risk of peptic ulcer disease, a selective COX-2 inhibitor plus PPI are needed. For patients with pre-existing hypertension receiving renin-angiotensin system blockers, empirical addition (or increase in the dose) of an antihypertensive agent of a different class should be considered. Bloodpressure and renal function should be monitored in most cases. Conclusion (...) -resistant hypertension, high risk of cardiovascular disease and severe chronic kidney disease (CKD). Before treatment with a NSAID is started, bloodpressure should be measured, unrecognised CKD should be screened in high risk cases, and unexplained iron-deficiency anaemia should be investigated. For patients with high cardiovascular risk, and if NSAID treatment cannot be avoided, naproxen or celecoxib are preferred. For patients with a moderate risk of peptic ulcer disease, monotherapy with a non
excessive weight gain and prevent gestational diabetes ( ). This systematic review assessed the effectiveness of exercise programs in preventing gestational hypertensivedisorders, defined as new onset highbloodpressure during pregnancy. There are four different types of gestational hypertensivedisorders: chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension (Vest et al., 2014). This CPSTF finding is specific to one type—gestational (...) hypertension without the development of preeclampsia-eclampsia. Summary of Results Detailed results from the systematic review are available in the . The systematic review and meta-analysis included 17 randomized controlled trials. Compared to interventions without an exercise program or to usual care, exercise programs reduced the development of highbloodpressure during pregnancy by 46% (17 studies) Additional analyses of a subset of 16 studies showed the following: The cesarean delivery rate
Risk of hypertension into adulthood in persons born prematurely: a national cohort study Preterm birth has been associated with elevatedbloodpressure early in life; however, hypertension risks from childhood into adulthood remain unclear. We conducted a large population-based study to examine gestational age at birth in relation to hypertension risks from childhood into adulthood.A national cohort study was conducted of all 4 193 069 singleton live births in Sweden during 1973-2014, who were (...) followed up for hypertension identified from nationwide inpatient and outpatient (specialty and primary care) diagnoses from any health care encounters through 2015 (maximum age 43 years; median 22.5). Cox regression was used to examine gestational age at birth in relation to hypertension risk while adjusting for other perinatal and maternal factors, and co-sibling analyses assessed the potential influence of unmeasured shared familial (genetic and/or environmental) factors. In 86.8 million person
Hypertension Self-management in Socially Disadvantaged African Americans: the Achieving BloodPressure Control Together (ACT) Randomized Comparative Effectiveness Trial Effective hypertension self-management interventions are needed for socially disadvantaged African Americans, who have poorer bloodpressure (BP) control compared to others.We studied the incremental effectiveness of contextually adapted hypertension self-management interventions among socially disadvantaged African (...) [95% CI] - 9.1 [- 15.1, - 3.1], - 7.4 [- 13.4, - 1.4], and - 11.3 [- 17.2, - 5.3] mmHg) and DBP (- 4.8 [- 8.3, - 1.3], - 4.0 [- 7.5, - 0.5], and - 5.4 [- 8.8, - 1.9] mmHg) for CHW, DoMyPART, and Problem Solving, respectively). There were no group differences in BP outcomes, BP self-monitor use, or clinic visit patient-centeredness. The Problem Solving group had higher odds of highhypertension self-care behaviors (OR [95% CI] 18.7 [4.0, 87.3]) and self-efficacy scores (OR [95% CI] 4.7 [1.5, 14.9
[23,24] and death from cancer  are higher in people who used antihypertensive drugs as compared with those without the medication. The risk is particularly high in people whose systolic bloodpressure is below 120 . In a recent cohort study, JACC study that followed about 28,000 people without cardiovascular disease, cancer, or renal disorder, the risk of death may be higher by 30% in antihypertensive users with lowest Review Review A: Intensive treatment compared with the standard treatment (...) of Hypertension Guidelines Part 2 NICE (UK) recommends treatment if bloodpressure is 160/100 or over Neglect of Correcting Scientific Fraud: Ruling over Diovan Scandal Advrse Reactions Tamiflu: Death After Abnormal Behaviour in Teenagers Revisited High Risk of Death from Tamiflu and Xofluza CONTENTS (December 2019, Vol. 5, No. 15 ) 37 38 44 48 50 52 Volume 5 December C M ED HECKMED CHECK December 2019/ Vol.5 No.15 · Page 37 References The Japanese Hypertension Guidelines 2019: Problem in Selection of Members
Impact of Moderate Aerobic Training on Physical Capacities of Hypertensive Obese Elderly. The association of old age and chronic conditions, such as hypertension and obesity, can lead to larger decreases in the physical capacities of elderly, compared with their healthy counterparts. Physical exercise has been demonstrated to be efficient in postponing this phenomenon, mainly strength training. However, little is known about the effect of aerobic training on this condition. The aim of this work (...) was to investigate the impact of 12 weeks of moderate-intensity aerobic training on the physical capacities of hypertensive obese older women. Aerobic power, lower limb muscle power, upper limb muscle strength, endurance, and flexibility of 19 hypertensive obese elders were evaluated. Afterward, patients were blindly randomized into control group (CG) and exercise group (EG). EG underwent three sessions/week of 60 min of moderate-intensity aerobic training, during 12 weeks. EG showed increases in VO2max compared
S8 online), or cardiomyopathy with elevated left ventricular end-diastolic filling pressures. AVT, acute vasoreactivity testing; ASD, atrial septal defect; CHD, congenital heart disease; iNO, inhaled nitric oxide; PAH, pulmonary arterial hypertension; PDA, patent ductus arteriosus; PH, pulmonary hypertension; PHVD, pulmonary hypertensive vascular disease; pre-OP, preoperatively; PVR, pulmonary vascular resistance; PVRi, pulmonary vascular resistance index; Qp, pulmonary blood flow; Qs, systemic (...) : , , , , , , , , Pulmonary hypertension (PH) and associated pulmonary vascular disease (PVD) are characterized by pulmonary vascular remodeling leading to elevated pulmonary arterial pressure and, over time, right ventricular (RV) dysfunction, underfilling/compression of the left ventricle, and terminal heart failure. x 1 Humbert, M, Guignabert, C, Bonnet, S et al. Pathology and pathobiology of pulmonary hypertension: State of the art and research perspectives. Eur Respir J . 2019 ; 53 , x 2 Vonk Noordegraaf, A, Chin
Cardiopulmonary exercise testing in a combined screening approach to individuate pulmonary arterial hypertension in systemic sclerosis The DETECT algorithm has been developed to identify SSc patients at risk for pulmonary arterial hypertension (PAH) yielding high sensitivity but low specificity, and positive predictive value. We tested whether cardiopulmonary exercise testing (CPET) could improve the performance of the DETECT screening strategy.Consecutive SSc patients over a 30-month period (...) were screened with the DETECT algorithm and positive subjects were referred for CPET before the execution of right-heart catheterization. The predictive performance of CPET on top of DETECT was evaluated and internally validated via bootstrap replicates.Out of 314 patients, 96 satisfied the DETECT application criteria and 54 were positive. PAH was ascertained in 17 (31.5%) and pre-capillary pulmonary hypertension in 23 (42.6%) patients. Within CPET variables, the slope of the minute ventilation
Hydrochlorothiazide and Squamous Cell Skin Cancer: Remember when hypertension was easy? 1 Tools for Practice is proudly sponsored by the Alberta College of Family Physicians (ACFP). ACFP is a provincial, professional voluntary organization, representing more than 4,800 family physicians, family medicine residents, and medical students in Alberta. Established over sixty years ago, the ACFP strives for excellence in family practice through advocacy, continuing medical education and primary care (...) research. www.acfp.ca November 25, 2019 (en français) Hydrochlorothiazide and Squamous Cell Skin Cancer: Remember when hypertension was easy? Clinical Question: Does hydrochlorothiazide increase the risk of squamous cell carcinoma (SCC) of the skin? Bottom Line: Observational data suggest an association between hydrochlorothiazide and the risk of SCC. Causation has not been proven. Risk appears to consistently increase with dose and duration (example: 5 years of use increases risk 3-4 times). Baseline
health insurers. In particular, the widespread use of the 2017 Hypertension Clinical Practice Guidelines classification scheme will also help to guide decision-making about when to prescribe antihypertensive medications in accordance with its current recommendations for the ACC/AHA stages of HBP (ie, stage 2, stage 1, and elevatedbloodpressure [BP]), as outlined in . Table 3. Guideline Recommendation for BP-Lowering Medications: ACC/AHA COR/LOE ASCVD Risk Stage 2 HighBP (≥140 mm Hg) Stage 1 High (...) about intensity of BP lowering and choice of antihypertensive drugs (COR: 2a, LOE: C-EO). ACC indicates American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, bloodpressure; COR, Class of Recommendation; and LOE, Level of Evidence. In the 2017 Hypertension Clinical Practice Guidelines, the authors emphasized the critical importance of measuring atherosclerotic cardiovascular disease (ASCVD) risk for all patients with HBP, regardless
Therapy for Pulmonary Arterial Hypertension in Adults: Update of the CHEST Guideline and Expert Panel Report Therapy for Pulmonary Arterial Hypertension in Adults - CHEST Follow CHEST: Email/Username: Password: Remember me Search Terms Search within Search Share this page Volume 155, Issue 3, Pages 565–586 To read this article in full, please review your options for gaining access at the bottom of the page. Therapy for Pulmonary Arterial Hypertension in Adults Update of the CHEST Guideline (...) . In these situations, other factors, such as patient preferences & values, cost, and insurance coverage, may guide decision-making. CCB = calcium channel blocker; 6MWD = 6-min walk distance; FC = functional class; PAH = pulmonary arterial hypertension; PH = pulmonary hypertension; RV = right ventricular; WHO = World Health Organization. Figure 1 Guideline algorithm for pharmacologic therapy for PAH in adults. Where multiple drug options are provided, there is no comparative effectiveness data to suggest greater
therapy, there is an upregulation of receptors, which can lead to an adrenergic surge if BBs are abruptly stopped. This is particularly seen with short-acting BBs. So, how do we prevent an adrenergic surge and appropriately taper? We don’t really know, as there haven’t been many studies. One study from back in 1982 compared a propranolol taper over 6 to 9 days versus over 2 weeks and found no difference in bloodpressure. Beta-adrenergic receptors have half-lives of 1.5 days, so tapering with halved (...) In patients taking a beta blocker for uncomplicated hypertension, what is the best way to taper it off? Chiefs’ Inquiry Corner 11/4/19 – Clinical Correlations Search Chiefs’ Inquiry Corner 11/4/19 November 4, 2019 2 min read Beta blockers (BBs) have fallen out of favor as first-line, or even second-line, treatment options for hypertension. And as patients’ medical regimens gradually drop BBs, concerns may arise about the rebound phenomenon we learn in medical school. With chronic beta blocker
) to ingest the entire daily dose of ≥1 hypertension medications at bedtime (n = 9552) or all of them upon awakening (n = 9532). At inclusion and at every scheduled clinic visit (at least annually) throughout follow-up, ambulatory bloodpressure (ABP) monitoring was performed for 48 h. During the 6.3-year median patient follow-up, 1752 participants experienced the primary CVD outcome (CVD death, myocardial infarction, coronary revascularization, heart failure, or stroke). Patients of the bedtime, compared (...) with the upon-waking, treatment-time regimen showed significantly lower hazard ratio-adjusted for significant influential characteristics of age, sex, type 2 diabetes, chronic kidney disease, smoking, HDL cholesterol, asleep systolic bloodpressure (BP) mean, sleep-time relative systolic BP decline, and previous CVD event-of the primary CVD outcome [0.55 (95% CI 0.50-0.61), P < 0.001] and each of its single components (P < 0.001 in all cases), i.e. CVD death [0.44 (0.34-0.56)], myocardial infarction [0.66