Tag Archives: hypertension

Navigating the changing landscape of cardiovascular commissioning A clear majority (58%) of GPs with a special interest in cardiology (GPSIs) feel unprepared to fulfill a commissioning role in the new NHS landscape, despite almost half of GPs being currently involved in commissioning, according to results from the REACCT (REAssessing Cardiology Commissioning and Treatment) report announced at the meeting. The report also reveals that a majority of cardiologists (57%) feel unprepared to take on new commissioning roles around the management of cardiovascular disease (CVD). The report (available from: www.pccs.org.uk/report) was written by the P

PARTNER: transcatheter valves just as good as surgery for high risk aortic stenosis Transcatheter aortic valve implantation (TAVI) is just as effective at reducing mortality as surgery for severe aortic stenosis in elderly patients whose age and overall health posed high risks for conventional surgery, according to the results of the PARTNER (Placement of AoRTic TraNscathetER Valve trial). However, stroke rates were higher in the trancatheter group. The transcatheter approach involves delivering a bioprosthetic valve to its target location with a catheter using either transfemoral access or trans-apical access (through the ribs) if peripheral

The trial, published online in The Lancet on January 12th 2011, also shows that patients who added in another drug at a later stage improved their response over monotherapy, but not to the same level as those who had begun with combination therapy. The authors, led by Dr Morris J Brown (University of Cambridge), say they hope the results “will reassure physicians and guideline committees of the safety of even full-dose initial combination and lead to the preference of this option in view of early and sustained superiority”. In an accompanying comment piece, Drs Ivana Lazich and George Bakris (University of Chicago Pritzker School of Medic

Highlights of the American Heart Association 2010 meeting held in November 2010, in Chicago, USA, included a breakthrough for the treatment of resistant hypertension, and another oral anticoagulant that could be used instead of warfarin in atrial fibrillation patients, without the need for monitoring. RAFT: CRT reduces deaths and hospitalisations in mild heart failure Adding cardiac-resynchronisation therapy (CRT) to implantable cardioverter defibrillator (ICD) and medication, led to a reduction in deaths and heart failure hospitalistions among patients with mild-to-moderate symptoms of heart failure in the RAFT (Resynchronisation-Defibrilla

An initial proof of principle study was reported in The Lancet (Krum H et al. Lancet 2009;373:1275–81) by Dr Henry Krum (Monash University, Melbourne, Australia) and co-investigators who, using the newly developed Symplicity® catheter system, performed RDN in 45 patients with resistant hypertension (systolic blood pressure [SBP] ≥160 mmHg on three antihypertensive agents); the procedure lasting a median of 38 minutes. The primary end points were office blood pressure (BP) and safety data at one, three, six, nine and 12 months, and patient’s renal angiography and magnetic resonance angiography during follow-up. BP was significantly redu

Impact of hypertension Epidemiological data have established a strong direct relationship between increased BP and raised cardiovascular (CV) disease risk. For individuals aged 40–69 years, each increment in systolic BP of 20 mmHg or diastolic BP of 10 mmHg doubles the risk of CV disease (i.e. stroke, ischaemic heart disease, and other vascular diseases) across the entire BP range.3 Figure 1. Prevalence of hypertension worldwide The World Health Organization has identified high BP as one of the most important preventable causes of premature morbidity and mortality. Antihypertensive drugs have convincingly been shown to be effective treatmen

1. Check that the measurement is correct Ensure that they really are poorly controlled by resting the patient for 10 minutes, with the cuff in place to discourage them from standing, before taking at least two measurements, one to two minutes apart. Feel the radial pulse because in arrhythmias such as atrial fibrillation automatic sphygmomanometers are inaccurate and therefore traditional devices such as mercury sphygmomanometers must be used. People aged over 80 years and some diabetics may have postural hypotension. This is where the systolic blood pressure drops 20 mmHg on standing or they may have postural symptoms.2 Having made that diag

ENHANCE controversy dominates meeting The controversial ENHANCE (Ezetimibe and Simvastatin in Hypercholesterolaemia Enhances Atherosclerosis Regression) trial of ezetimibe dominated the ACC meeting, with a special session held to discuss the results, which were simultaneously published in the New England Journal of Medicine. The 720-patient trial showed no benefit of ezetimibe when added to simvastatin 80 mg in slowing the progression of atherosclerosis in the carotid artery (as measured by intima media thickness (IMT) in patients with familial hypercholesterolemia (FH), despite the fact that there were significantly greater reductions in lo

The US authors conclude that their findings “may have potentially broad public-health implications, given the high prevalence of vitamin D deficiency in developed countries, the contribution of lifestyle and geography to vitamin D status, and the ease, safety and low cost of treating vitamin D deficiency”. In the study, published in Circulation (online January 7th 2008), 1,739 participants, free of cardiovascular disease at baseline, were followed for a median of 5.4 years and 120 individuals developed a first cardiovascular event. After adjustment for conventional cardiovascular risk factors, individuals with 25-OH D levels below 15 ng/

Momentous achievements The changes made in the diagnosis and management of cardiovascular disease over the past 10 years, led by primary care, were described as “momentous” by Primary Care Cardiovascular Society (PCCS) past chairman and board member Professor Richard Hobbs (Department of General Practice and Primary Care, University of Birmingham). Presenting the opening address ‘A decade of advances in cardiovascular disease’ at the two-day annual scientific meeting, he said: “Primary care teams have led advances in the treatment of cardiovascular disease and cardiovascular risk factors. They should feel very proud of the contribut