Tag Archives: therapeutics

Introduction Acute heart failure (AHF) syndromes are the leading cause of hospitalisation in patients over 65 years of age in the UK, accounting for 67,000 admissions per year.1 The immediate management of AHF focuses on symptom relief and stabilisation of the patient’s haemodynamic profile – traditionally achieved with a combination of oxygen, diuretics and nitrate therapy.1-5 Recent guidelines from the National Institute for Health and Care Excellence (NICE),1 and the European Society of Cardiology (ESC),5 have highlighted the poor-quality evidence base for many of these interventions.3,4,6 The ESC guidelines (updated in 2016) state th

Introduction Large intervention studies suggest that while lowering low-density lipoprotein cholesterol (LDL-C) is beneficial, it is insufficient to prevent the majority of coronary heart disease (CHD) events. Niacin improves the overall lipid profile, LDL-C and triglycerides (TG) and is the most effective agent for raising high-density lipoprotein cholesterol (HDL-C) levels.1 Co-administration of niacin with a statin offers the potential for additional lipid management, but the use of niacin has been limited due to associated flushing, mediated primarily by prostaglandin D2 (PGD2).2 Flushing of the face and trunk occurs in nearly all patient

Introduction Drugs that block the renin–angiotensin–aldosterone system, the angiotensin-converting enzyme inhibitors (ACEIs) and the angiotensin-receptor blockers (ARBs), have been shown to be effective in the management of hypertension, heart failure and several forms of renal disease including diabetic nephropathy. For this reason, the use of these agents is likely to increase steadily in the coming years. It is also clear from many of the randomised controlled trials that there is a dose-response curve for these agents, with higher doses being more effective.1-6 In the course of our clinical practice in acute general medicine, we obser