187 research outputs found
Supplemental Material, Menarini_angina_Supplementary_v1.2 - Sta<i>B</i>le Angina: Pe<i>R</i>cept<i>I</i>on of Nee<i>D</i>s, Quality of Life and Mana<i>G</i>em<i>E</i>nt of Patients (BRIDGE Study)—A Multinational European Physician Survey
No full textSupplemental Material, Menarini_angina_Supplementary_v1.2 for StaBle Angina: PeRceptIon of NeeDs, Quality of Life and ManaGemEnt of Patients (BRIDGE Study)—A Multinational European Physician Survey by Giuseppe Ambrosio, Peter Collins, Ralf Dechend, Jose Lopez-Sendon, Athanasios J. Manolis, and A. John Camm in Angiology</p
ARB-based single-pill platform to guide a practical therapeutic approach to hypertensive patients
No full textHypertension is a major modifiable risk for the development of cardiovascular, cerebrovascular and renal diseases. Thus, effective treatment of high blood pressure is an important strategy for reducing disease burden; however, in spite of the availability of numerous effective therapies only 30-40 % of patients with hypertension achieve the recommended blood pressure goals of <140/90 mmHg. Lack of adherence to therapy and reluctance to intensify therapy are cited frequently to explain the discrepancy between potential and attained outcomes. Adherence is closely related to the tolerability, effectiveness and complexity of therapy. Therapeutic inertia may be influenced by concerns over tolerability, as well as the lack of clear preferences for therapies when managing patients with risk factors and comorbidities. Effective and well-tolerated single pill combination therapies are now available that improve adherence and simplify treatment. The combination of a renin-angiotensin system blocker with a calcium channel blocker and a diuretic improves adherence to therapy. We have devised a practical tool for orienting the application of well-tolerated single pill 2/3 drug fixed dose combination therapies in clinical situations commonly encountered when treating hypertensive patients. This approach employs the angiotensin receptor blocker olmesartan alone or in combinations with amlodipine and/or hydrochlorothiazide. This platform is based on clinical evidence, guidelines, best practice, and clinical experience where none of these is available. We believe it will increase the percentage of hypertensive patients who achieve blood pressure control when applied as part of an integrative approach that includes regular follow-up and instruction on lifestyle changes. © 2014 Springer International Publishing
Erratum to: ARB-Based Single-Pill Platform to Guide a Practical Therapeutic Approach to Hypertensive Patients.
No full textHypertension is a major modifiable risk for the development of cardiovascular, cerebrovascular and renal diseases. Thus, effective treatment of high blood pressure is an important strategy for reducing disease burden; however, in spite of the availability of numerous effective therapies only 30-40 % of patients with hypertension achieve the recommended blood pressure goals of <140/90 mmHg. Lack of adherence to therapy and reluctance to intensify therapy are cited frequently to explain the discrepancy between potential and attained outcomes. Adherence is closely related to the tolerability, effectiveness and complexity of therapy. Therapeutic inertia may be influenced by concerns over tolerability, as well as the lack of clear preferences for therapies when managing patients with risk factors and comorbidities. Effective and well-tolerated single pill combination therapies are now available that improve adherence and simplify treatment. The combination of a renin-angiotensin system blocker with a calcium channel blocker and a diuretic improves adherence to therapy. We have devised a practical tool for orienting the application of well-tolerated single pill 2/3 drug fixed dose combination therapies in clinical situations commonly encountered when treating hypertensive patients. This approach employs the angiotensin receptor blocker olmesartan alone or in combinations with amlodipine and/or hydrochlorothiazide. This platform is based on clinical evidence, guidelines, best practice, and clinical experience where none of these is available. We believe it will increase the percentage of hypertensive patients who achieve blood pressure control when applied as part of an integrative approach that includes regular follow-up and instruction on lifestyle change
Hypertension Control: J-Curve Revisited
No full textOver the last three decades there is an increasing number of investigators and meta-analyses focusing on the dangers of lowering blood pressure below certain levels. Several studies such as Invest, Ontarget, Value and TNT showed a significant decrease in cardiovascular morbidity and mortality by lowering blood pressure levels. However, blood pressure decrease below a certain level had exactly the opposite effect. The increase of cardiovascular morbidity and mortality was attributed to the excessive reductions in blood pressure which may explain why in major clinical trials blood pressure below certain levels increases cardiovascular adverse events mainly in patients with coronary heart disease. In these patients a fall in diastolic blood pressure might lower perfusion pressure distal to a stenosis below a critical level at which autoregulation is effective. This phenomenon led the European Society of Hypertension to propose a "J-shaped curve" relationship between blood pressure and cardiac morbidity and mortality, whereby lowering blood pressure below a critical point is no longer beneficial and possibly even deleterious. The challenge is to better define the limits of intervention and to define groups of people who are particularly vulnerable to over-aggressive lowering of blood pressure
AHA! meets Auld Linky : Integrating Designed and Freeform Hypertext Systems
No full textIn this paper we present our efforts to integrate two adaptive hypermedia systems that take very different approaches. The Adaptive Hypermedia Architecture (AHA!) aims to establish a consistently organized, strictly designed form of hypertext while Auld Linky takes an open and potentially sculptural approach, producing more freeform, less deterministic hypertexts. We describe the difficulties in reconciling the two approaches. This leads us to draw a number of conclusions about the benefits and disadvantages of both and the concessions that are required to combine them successfully
Personalised Single-Pill Combination Therapy in Hypertensive Patients: An Update of a Practical Treatment Platform
No full textDespite the improvements in the management of hypertension during the last three decades, it continues to be one of the leading causes of cardiovascular morbidity and mortality worldwide. Effective and sustained reductions in blood pressure (BP) reduce the incidence of myocardial infarction, stroke, congestive heart failure and cardiovascular death. However, the proportion of patients who achieve the recommended BP goal (< 140/90 mmHg) is persistently low, worldwide. Poor adherence to therapy, complex therapeutic regimens, clinical inertia, drug-related adverse events and multiple risk factors or comorbidities contribute to the disparity between the potential and actual BP control rate. Previously we published a practical therapeutic platform for the treatment of hypertension based on clinical evidence, guidelines, best practice and clinical experience. This platform provides a personalised treatment approach and can be used to improve BP control and simplify treatment. It uses long-acting, effective and well-tolerated angiotensin receptor blocker (ARB) olmesartan, in combination with a calcium channel blocker amlodipine, and/or a thiazide diuretic hydrochlorothiazide. These drugs were selected based on the availability in most European Countries of single-pill, fixed formulations in a wide range of doses for both dual- and triple-drug combinations. The platform approach could be applied to other ARBs or angiotensin-converting enzyme inhibitors available in single-pill, fixed-dose combinations. Here, we present an update, which takes into account the results of the recently published studies and extends the applicability of the platform to common conditions that are often neglected or poorly considered in clinical practice guidelines
Impact of stable angina on health status and quality of life perception of currently treated patients. The BRIDGE 2 survey.
No full textOBJECTIVE: to explore 1) the perception of stable angina (SA) - impact on quality of life (QoL) and current condition related to SA; 2) SA burden - symptoms and frequency of anginal episodes; 3) impairment attributable to SA - limitations in daily activities and impact on work; 4) characteristics that might affect the patients' perception." METHOD: a proprietary questionnaire was administered on-line to SA patients selected using a purpose-built screening program from general population panels collaborating with IQVIA in Italy, Germany, Spain, and the UK. Exploratory analyses were performed: descriptive statistics on the total sample and different stratifications (gender, age class, time since diagnosis) were provided; we used Chi-square tests to compare subgroups. RESULTS: of more than 25,000 subjects who accessed the survey, 268 were eligible and completed the questionnaire: mean age was 61 years and women accounted for 30%. Despite being treated, about 40% of patients reported that SA impacted "completely" or "very much" their QoL, 10% rated their condition as "not good", and 45.1% stated that they felt "Fair". The majority of patients were still symptomatic and many of them perceived that SA had a major impact on their working life. Women, younger patients and those with a more recent diagnosis reported a worse self-assessment of their condition, QoL and symptom burden. CONCLUSIONS: the results of our survey provide new insights on how patients with SA perceived their own health status and suggest that any patient with SA deserves a more detailed and accurate evaluation by their physicians
European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts).
No full textOther experts who contributed to parts of the guidelines: Edmond Walma, Schoonhoven (The Netherlands), Tony Fitzgerald, Dublin (Ireland), Marie Therese Cooney, Dublin (Ireland), Alexandra Dudina, Dublin (Ireland) European Society of Cardiology (ESC) Committee for Practice Guidelines (CPG):, Alec Vahanian (Chairperson) (France), John Camm (UK), Raffaele De Caterina (Italy), Veronica Dean (France), Kenneth Dickstein (Norway), Christian Funck-Brentano (France), Gerasimos Filippatos (Greece), Irene Hellemans (The Netherlands), Steen Dalby Kristensen (Denmark), Keith McGregor (France), Udo Sechtem (Germany), Sigmund Silber (Germany), Michal Tendera (Poland), Petr Widimsky (Czech Republic), José Luis Zamorano (Spain)
Document reviewers: Irene Hellemans (CPG Review Coordinator) (The Netherlands), Attila Altiner (Germany), Enzo Bonora (Italy), Paul N. Durrington (UK), Robert Fagard (Belgium), Simona Giampaoli(Italy), Harry Hemingway (UK), Jan Hakansson (Sweden), Sverre Erik Kjeldsen (Norway), Mogens Lytken Larsen (Denmark), Giuseppe Mancia (Italy), Athanasios J. Manolis (Greece), Kristina Orth-Gomer (Sweden), Terje Pedersen (Norway), Mike Rayner (UK), Lars Ryden (Sweden), Mario Sammut (Malta), Neil Schneiderman (USA), Anton F. Stalenhoef (The Netherlands), Lale Tokgözoglu (Turkey), Olov Wiklund (Sweden), Antonis Zampelas (Greece
Serum uric acid and the risk of cardiovascular and renal disease
No full textSubstantial evidence suggests that chronic hyperuricemia is an independent risk factor for hypertension, metabolic syndrome, chronic kidney disease (CKD) and cardiovascular diseases. This highlights the need for greater attention to serum uric acid levels when profiling patients, and suggests that the threshold above which uricemia is considered abnormal is 6 mg/dl, in light of the available evidence. Another important question is whether lowering serum uric acid can improve cardiovascular and renal outcomes, and what therapeutic mechanism of action could provide more clinical benefits to patients; the available literature shows a trend toward improvement associated with administration of urate-lowering drugs, in particular for the xanthine oxidase inhibitors. The demonstrated efficacy of urate-lowering therapy on outcomes other than gout flares leads to the consideration that treatment may be beneficial even in the absence of overt gout when hyperuricemia accompanies other clinical conditions, such as urate deposition, advanced CKD or cardiovascular risk factors
Expert consensus document: A 'diamond' approach to personalized treatment of angina.
No full textIn clinical guidelines, drugs for symptomatic angina are classified as being first choice (β-blockers, calcium-channel blockers, short-acting nitrates) or second choice (ivabradine, nicorandil, ranolazine, trimetazidine), with the recommendation to reserve second-choice medications for patients who have contraindications to first-choice agents, do not tolerate them, or remain symptomatic. No direct comparisons between first-choice and second-choice treatments have demonstrated the superiority of one group of drugs over the other. Meta-analyses show that all antianginal drugs have similar efficacy in reducing symptoms, but provide no evidence for improvement in survival. The newer, second-choice drugs have more evidence-based clinical data that are more contemporary than is available for traditional first-choice drugs. Considering some drugs, but not others, to be first choice is, therefore, difficult. Moreover, double or triple therapy is often needed to control angina. Patients with angina can have several comorbidities, and symptoms can result from various underlying pathophysiologies. Some agents, in addition to having antianginal effects, have properties that could be useful depending on the comorbidities present and the mechanisms of angina, but the guidelines do not provide recommendations on the optimal combinations of drugs. In this Consensus Statement, we propose an individualized approach to angina treatment, which takes into consideration the patient, their comorbidities, and the underlying mechanism of disease
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