I attended the meeting of European Society for Hypertension in Oslo Norway, during June 18 - 21, 2010.
I note this year there were no new blockbuster drugs released at the time of the meeting nor were there any major clinical trials released for review.
There was lots of practical information related to obesity, salt intake and exercise in the management and treatment of hypertension as well as several excellent lectures on different aspects of hypertension and newer combinations of medications such as Coversyl with amlodipine (Coveram) and Nifedipine and Telmisartan.
Dr. Bakris and I met at a recent ASN meeting and discussed a tool that can be used in primary care screening for nephropathy. Subsequent to that, Dr. Bakris wrote the paper below with the screening device utilized in the trial.
- Dr Murray Awde
A Comparative Evaluation of Various Methods for Microalbuminuria Screening
Pantelis A. Sarafidis a, c Jessica Riehle a Zvezdana Bogojevic a Emad Basta a Atul Chugh b George L. Bakris b
a Hypertension/Clinical Research Center, Department of Preventive Medicine, Rush University Medical Center, and b Hypertensive Diseases Unit, Section of Endocrinology, Diabetes and Metabolism, University of Chicago-Pritzker School of Medicine, Chicago, Ill. , USA; c Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA University Hospital, Aristotle University of Thesaloniki, Thessaloniki , Greece
Key Words - Urinary albumin excretion, Hypertension, Diabetes, Kidney disease
Abstract
Background/Aims: Microalbuminuria is a marker of abnormal vascular response and a predictor of cardiovascular morbidity and mortality. We evaluated a new quantitative office-based method to assess urinary albumin excretion (UAE) and compared it to other established methods.
The term whiplash refers to an injury to your neck which is caused by the head being thrown forward (flexion), then backward (extension). (See picture below)
Other terms for whiplash can be neck sprain or strain, and it is an injury to the soft tissues (muscles, ligaments and tendons) of the neck. It most often occurs as a result of rear-end car collision, but can also happen during a fall, or from an injury while playing sports. Severe whiplash can also involve injury to the joints, discs, neck muscles and nerves. Symptoms may start right after the injury or may take several days to become noticeable.
Patients who suspect they have the flu should NOT rush to the doctors office.
Diabetes is a serious condition with potentially devastating complications that affects all age groups (1). In Canada, it is estimated that 1.4 million Canadians had diabetes in the year 2000; a projected increase to 2.4 million is expected by the year 2016.
Good sleep is vital for healthy living. In fact, it is as important as good nutrition and physical fitness. For those with untreated Obstructive Sleep Apnea Syndrome (OSAS) work and relationships may also be affected. Untreated OSAS is associated with an increased risk of co-morbid associations such as cardiovascular disease, hypertension, and development of Type 2 Diabetes. OSAS is highly under-diagnosed. Symptoms are often treated while the underlying cause is undetermined.
At the EASD in Vienna 2009, newer classes of drugs for type II diabetes were discussed. Some have been released in Europe while others are still awaiting release in North America.
Three distinct classes of drugs are available. The class released in Canada to date are the oral agents called DPP-4 inhibitors (gliptins). There will be 4 available by Merck, AZ/BMS, Novartis and BI.
These drugs compete in the gut for binding sites much like ACEI do for hypertension blocking glucose absorption. They offer advantage of being orally administered, single dosing, weight control or reduction and side effect profile similar to placebo.
The next class of drugs are called GLP-1 mimetics, these are glucagon like compounds given once or twice.
Population studies in the 1970s and 1980s suggested that moderate drinkers were at lower risk for developing coronary artery disease (CAD) than abstainers and heavy drinkers
Heavier drinking is associated with forms of cardiovascular disease such as cardiomyopathy (Damage to the heart muscle) (Klastsky 1982; Regan 1984); hypertension (high blood pressure) (Klatsky 1990); hemorrhagic strokes (rupturing of blood vessels which leads to brain damage) (Donahue et al. 1986a; Stampfer et al. 1988a); and heart rhythm disturbances (Ettinger et al. 1978; Cohen et al.)
Trial Name: ACTIVE I
Release Date: September 2009
Medical Condition studied: Atrial Fibrillation
Drugs compared: Irbesartan (BMS/Sanofi)
Number of sites and Patients: 9016 patients in multicentres. International
Definition:
Low back pain is not a specific disease. It is a symptom that can occur from many different processes. The back is a well-designed structure made up of bone, muscles, nerves and other soft tissues. More specifically, the lumbar spine (low back) is made up of five vertebrae, often referred to as L1 to L5. The lower back bears most of the weight and stress of the human body. Consequently, the back is vulnerable to injury and pain.
Trial Name: HORIZON
Release Date: April 2009
Medical Condition studied: Glucocorticoid induced osteoporosis
Drugs compared: 5mgm Zoledronic acid (Novartis) vs Risedronate 5 mgm OD
Number of sites and Patients: 833 patients in 54 centres multinational
Trial Name: PLATO
Release Date: 2009
Medical Condition studied: in patients with ACS, Hypertension, dyslipidemia, chronic tobacco use and diabetes mellitus
Drugs compared: Ticagrelor vs Clpidogrel in patients with acute coronary syndrome.
Number of sites and Patients: 18,624 patients from 862 centres in 43 countries.
Trial News
Trial Name: RE-LY
Release Date: September 2009
Medical Condition studied: Atrial Fibrillation
Drugs compared: Dabigatran (BI) vs Warfarin
Number of sites and Patients: 18,113 patients in 44 countries with 951 clinical centres
EGFR is a marker for the progression of Chronic Kidney Disease (CKD). An easy way to think about eGFR is imagine all healthy patients are born with an eGFR of 100 and lose 1% per year throughout life.
This was a 4 year clinical trial comparing dustasteride (GSK) versus placebo in an at risk population for the development of prostate cancer.
Achilles tendinopathy is a clinical syndrome often associated with overuse that is characterized by pain and inflammation of the tendon, which results in impaired performance and altered function.
Hearing loss is the third only to arthritis and hypertension as the most common complaint of older adults. By 2015, more than 35 million people with hearing loss live in the United States. Currently, there are almost three and half million impaired hearing people living in Canada.
This was a large multinational primary prevention statin trial involving over 17,800 patients in 26 countries.
At a recent 2009 A.S.H meeting in San Francisco, Hypertension for family physicians was reviewed at length with highlights of the latest clinical trials such as ONTARGET, PROGRESS, ACCOMPLISH and STITCH.
