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Preoperative activation of the renin-angiotensin system and myocardial injury in noncardiac surgery: exploratory mechanistic analysis of the SPACE randomised controlled trial.
Br J Anaesth
December 2024
Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK. Electronic address:
Background: Hypertension therapy in older adults is often suboptimal, in part because of inadequate suppression of the renin-angiotensin-aldosterone system (RAAS). We hypothesised that distinct endotypes of RAAS activation before noncardiac surgery are associated with increased risk of myocardial injury.
Methods: This was a prespecified exploratory analysis of a multicentre randomised controlled trial (ISRCTN17251494) which randomised patients ≥60 yr old undergoing elective noncardiac surgery to either continue or stop RAAS inhibitors (determined by pharmacokinetic profiles).
Comparison between the effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers and their combination on mortality in maintenance dialysis patients: a systematic review and meta-analysis.
Int Urol Nephrol
December 2024
Internal Medicine Department, Loma Linda University Medical Center-Murrieta, Murrieta, CA, USA.
Introduction: Patients undergoing maintenance dialysis have a higher mortality rate compared to the general population. It is known that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have protective effects on the kidney; however, few studies have directly compared their impact on mortality in patients undergoing dialysis. This study aims to evaluate the effectiveness of ACEIs, ARBs, or their combination in reducing all-cause and cardiovascular mortality in maintenance dialysis patients.
View Article and Find Full Text PDFAntihypertensive Treatment Patterns in CKD Stages 3 and 4: The CKD-REIN Cohort Study.
Kidney Med
December 2024
Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France.
Article Synopsis
- Blood pressure (BP) control is crucial for preventing complications in chronic kidney disease (CKD), yet many patients struggle to reach target levels; this study evaluates how antihypertensive prescriptions change over time in CKD patients.
- Conducted with 2,755 hypertensive CKD patients in France, the study tracked factors influencing prescription changes, such as patient demographics and healthcare provider interactions.
- Results showed that over five years, there was a high rate of changes in medication; poor adherence to medications increased the likelihood of needing additional drugs, while having a lower education level led to more frequent withdrawals of antihypertensive medications.
Background: The win ratio (WR) is an emerging alternative for reporting composite outcomes, prioritizing clinically significant events such as mortality while incorporating surrogate measures. However, its benefits should be weighed against limitations, particularly the influence of lower hierarchical outcomes. This secondary analysis of the PARAGLIDE-HF trial performed a WR sensitivity analysis using a modified hierarchical composite outcome to assess the utility of WR sensitivity analysis and the efficacy of sacubitril/valsartan versus valsartan.
View Article and Find Full Text PDFNoninsulin antidiabetic prescription patterns in Colombia: a cross-sectional study.
Ther Adv Endocrinol Metab
October 2024
NovoNordisk Colombia SAS, Bogota, Colombia.
Article Synopsis
- - The study investigates the prescription patterns of noninsulin antidiabetic medications among 155,381 Colombian patients with type 2 diabetes mellitus (T2DM), primarily focusing on the most commonly prescribed drugs and their usage in combination therapy.
- - Metformin emerged as the most frequently prescribed antidiabetic, followed by empagliflozin, sitagliptin, linagliptin, and dapagliflozin, with a significant portion of patients (55.5%) receiving combinations of two or three medications.
- - Despite advancements in treatment guidelines, many T2DM patients with related cardiovascular conditions are not receiving optimal antidiabetic therapy, indicating a need for better access to drugs that might reduce cardiovascular risk, like sodium
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