Tag Archives: hypertension

Aggressive risk factor modification: 30 year follow-up of IHD and non-haemorrhagic stroke Dear Sirs, In a single doctor’s practice in a high-risk area of South Sheffield, aggressive measures were taken to prevent ischaemic heart disease (IHD) and non-haemorrhagic stroke (ST) since 1980. Four cardinal risk factors were detected: smoking, diabetes, hypertension and cholesterol. Smoking, diabetes and hypertension were treated critically using standard guidelines and applying the latest evidence available independent of cost from 1980 onwards. Mortality from IHD has been known for many years to be directly related to the level of serum choleste

HEAT-PPCI: heparin outperforms bivalirudin in primary PCI The major talking point of this year’s American College of Cardiology meeting was without doubt the aptly named HEAT-PPCI trial which generated more heat than has been seen at such conferences for quite some time. The trial acronym stands for How Effective Are Antithrombotic Therapies in Primary PCI (percutaneous coronary intervention), and the study – conducted in the UK under the leadership of Dr Rod Stables (Liverpool Heart and Chest Hospital) – compared unfractionated heparin with bivalirudin (Angiomax®, the Medicines Company) in patients with ST-elevation myoca

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Rather than a structured textbook this is a collection of individual essays, some of which are very useful and interesting, and some not quite so good. There are 38 contributors for 18 chapters. Compiled for doctors ranging from the internist to the specialist, it is very much an American text. Outside of the US it will arouse the curiosity of those of us interested in hypertension, more in terms of an insight into the current thoughts of our American cousins. One particular insight is the recommendation to do urine spot tests for sodium and potassium levels, to check adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, with

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Activities The Society has been instrumental in developing guidelines for the management of hypertension, which have been modified on a variety of occasions. In particular, we have interacted with the National Institute for Health and Clinical Excellence (NICE) on their last two guidelines. Both the BHS and NICE guidelines are looked upon as highly influential worldwide. We have also successfully lobbied Government in respect to reducing dietary salt in foodstuffs. It is likely that more stringent Quality Outcome Framework blood pressure treatment targets will be introduced next year as a direct result of the Society’s influence. BHS Member

CORONARY: off-pump and on-pump CABG similar The largest trial ever to compare off-pump and on-pump coronary artery bypass surgery (CABG) has shown no difference between the two techniques in terms of the primary composite end point. There were, however, some differences in certain end points, leading to the suggestion that the decision as to which approach to choose could be individualised with each patient. Table 1. Main results from the CORONARY trial The CORONARY trial enrolled 4,752 patients who were randomised to off-pump or on-pump surgery. At 30 days the primary end point – a composite of death, myocardial infraction (MI), kidney fai

NICE updates A new ‘Evidence Update’ has been produced by the National Institute for Health and Clinical Excellence (NICE), which summarises selected new evidence relevant to the NICE guideline on the management of chronic heart failure (CHF) in adults in primary and secondary care (clinical guideline 108).NICE says “Whilst Evidence Updates do not replace current accredited guidance, they do highlight new evidence that might generate a future changes in practice.”  It says it will welcome feedback from societies and individuals in developing this service. The update is available from www.evidence.nhs.uk/evidence-update-2. New guides

Every day practice This year’s meeting examined the importance of both pulse and blood pressure in everyday clinical practice. Professor Tom McDonald (University of Dundee), Vice President of the BHS, welcomed delegates to the symposium on blood pressure and vascular disease, held in conjunction with the BHS. Current interest in the subject results from the publication last year of National Institute for Health and Clinical Excellence (NICE) clinical guideline 127 on the clinical management of primary hypertension in adults, and its recommended approach to hypertension diagnosis and blood pressure management.1 The first speaker, Professor M

Key new recommendations include the following: Diagnosis of primary hypertension should be confirmed using 24–hour ambulatory blood pressure monitoring, or home blood pressure monitoring, rather than be based solely on measurements of blood pressure taken in the clinic. This is to reduce the occurrence of white coat hypertension, which recent studies have suggested is causing the misdiagnosis of hypertension in up to a quarter of the 12 million patients currently labeled with the condition. For the treatment of hypertension, the guideline now recommends that calcium channel blockers (CCBs) should be the first choice of agent used in patien