ACE inhibitors vs ARBs Myths and Facts
|
|
- Lee Fleming
- 5 years ago
- Views:
Transcription
1 ACE inhibitors vs ARBs Myths and Facts Prof. Dr. med. Frank Ruschitzka, FRCP (Edinburgh) Director Heart Failure/Transplantation Clinic University Clinic Zurich Switzerland Conflict of interest: Bayer, Biomarin, Biotronik, Cardiorentis, Merck, Pfizer, Novartis, Sanofi, St. Jude Medical Interest in Conflict: none
2 Blood Pressure Regulation ACE-Inhibitor Ang II -Blocker Calcium-Ant. Beta-Blocker Diuretic
3 Angiotensin II Plays a Central Role in Organ Damage
4 Renin-Angiotensin-Aldosterone System Vasoconstriction, Oxidative Stress, Cellular Growth BIRKENHÄGER LANCET 2007
5 ACE-inhibitors in high risk patients 55 years of age: HOPE trial - 9,297 patients - Documented CAD or DM + 1 RF CV death, AMI or stroke RRR 28% (14-30) - No history of CHF or LV dysfunction RR: 0.78 ( ) The HOPE investigators. N Engl J Med 2000 ; 342 :
6 EUROPA: results 14 CV death, AMI or resuscitated cardiac arrest patients with stable CAD no CHF Placebo Perindopril 8mg RRR: 20% [95% CI : 9-29] p = ans Annual event rate (placebo) : 2.4 % Lancet 2003; 362:
7 Meta-analysis of ACE inhibitor trials in CAD patients without HF or LV dysfunction % P< % P< % P< % P< % P= % P< % P<0.001 * End point not reported in QUIET ** End point not reported in PEACE and CAMELOT Danchin N et al. Arch Int Med. 2006;166:
8 All-cause mortality reduction in trials with Perindopril (n= patients) n HR ASCOT-BPLA ( ), P=0.025 amlodipine/perindopril HYPERTENSIVES HYVET ( ), P=0.02 indapamide/perindopril OLD HYPERTENSIVES ADVANCE ( ), P=0.025 perindopril/indapamide DIABETICS Total ( ) Active better Control better 0,5 0,75 1 1,25 1,5, P<0.001
9 ACE-Inhibitor is first choice-so what.s the ideal partner? ESC/ESH Guidelines for Management of Hypertension 2007
10 Give my Husband a Betablocker, please!
11 ASCOT: Benefit of Perindopril/Amlodipin over Atenolol/Diuretic 19,257 hypertensive patients P. Sever, Lancet 2005
12 New Treatment Algorhythm for Hypertension (British Hypertension Society) 2006
13 ACE-Inhibitors and Calciumantagonists Combination Therapy of First Choice ESC/ESH Guidelines for Management of Hypertension 2007
14 Is an ARB as good as an ACE-Inhibitor?
15 The Renin-Angiotensin System Bradykinin degradation Adrenalin release Selective AT 1 - receptor blockade Angiotensinogen Renin ACE Angiotensin I Angiotensin II AT 1 AT 2 Renin inhibition ACE inhibition Alternative pathways AT 3 AT 4 Inflammatory responses Aldosterone production Na +, H 2 O Vasopressin reabsorption release?
16 Does a class effect of ACE inhibitors and Sartans exist?
17 Does a class effect of ACE inhibitors and Sartans exist? Testosterone Estrogen
18 The Class Effect Myth Krum and Ruschitzka 2006
19 Are ACE inhibitors and Sartans created equal? N N CI COOH CH 3 N CH 3 O N CO 2 H N N N NH N N N O OH N N CH 3 Valsartan N N H Losartan (active form) Telmisartan N N O N S HOOC N NH N N N OCH 2 CH 3 N Candesartan (active form) N COCH COCH Eprosartan N N NH N Irbesartan
20 Are ACE inhibitors and Sartans created equal? N N CI COOH CH 3 N CH 3 O N CO 2 H N N N NH N N N O OH N N CH 3 Valsartan N N H Losartan (active form) Telmisartan Perindopril N N O N S HOOC N NH N N N OCH 2 CH 3 N Candesartan (active form) N COCH COCH Eprosartan N N NH N Irbesartan
21 Transcend (ACE-Inhibitor intolerant) Lancet 2008
22 Transcend: Telmisartan fails to prevent cardiovascular death, myocardial infarction,stroke, or heart failure hospitalisation Lancet 2008
23 Telmisartan Does Not Prevent Recurrent Stroke in ProFESS Yusuf NEJM Aug 28, 2008
24 Perindopril/Indapamid Prevent Stroke (PROGRESS) f/u 3.9 y RRR -28% ARR -3.7% NNT 27 Placebo (Perindopril ± Indapamide) Lancet 2001
25 Candesartan in Acute Stroke: SCAST Sandset, Lancet 2011
26 Candesartan in Acute Stroke: SCAST Sandset, Lancet 2011
27 Candesartan in Acute Stroke: SCAST Sandset, Lancet 2011
28 Candesartan in Acute Stroke: SCAST Sandset, Lancet 2011
29 Candesartan in Acute Stroke: SCAST Sandset, Lancet 2011
30 Navigator: Valsartan off-course Time to Rethink the Value of Sartans? Califf ACC NEJM 2010
31 ADVANCE: Perindopril reduces All-cause Mortality in Diabetes Lancet 2007
32 Renal Effects of Enalapril versus Losartan in Diabetes Maurer NEJM 2009
33 What.s the VALUE of Valsartan? Increased Risk of MI associated with Valsartan in VALUE VALUE Trial: Combined Primary Endpoint VALUE Trial: Myocardial Infarctions Julius Lancet 2004
34 Tendency Towards Increased Risk of Strokes associated with Valsartan in VALUE Julius Lancet 2004
35 OPTIMAAL: Crude rates and relative risks for prespecified endpoints Losartan Captopril Relative risk p (n=2744) (n=2733) (95% CI) All-cause mortality 499 (18 2%) 447 (16 4%) 1 13 ( ) SCD/RCA 239 (8 7%) 203 (7 4%) 1 19 ( ) Myocardial reinfarction (fatal/non-fatal)* 384 (14 0%) 379 (13 9%) 1 03 ( ) Other prespecified endpoints MI/total mortality 746 (27 2%) 689 (25 2%) 1 10 ( ) Cardiovascular death 420 (15 3%) 363 (13 3%) 1 17 ( ) Stroke (fatal/ non-fatal) 140 (5 1%) 132 (4 8%) 1 07 ( ) CABG 404 (14 7%) 375 (13 7%) 1 09 ( ) PTCA 466 (17 0%) 492 (18 0%) 0 94 ( ) Revascularisation 845 (30 8%) 827 (30 3%) 1 03 ( ) First all-cause admission 1806 (65 8%) 1774 (64 9%) 1 03 ( ) First admission for heart failure 306 (11 2%) 265 (9 7%) 1 16 ( ) Cardiovascular admission 1480 (53 9%) 1421 (52 0%) 1 06 ( ) Non-cardiovascular admission 885 (32 3%) 905 (33 1%) 0 98 ( ) Lancet 2002;360:752-60
36 Does the ARB paradox exist? Strauss and Hall Circulation 2006
37
38 ...but ARBs Fail to Prevent Myocardial Infarctions Messerli, Bangalore, Ruschitzka Eur Heart J 2009
39 ACTIVE 1 NEJM 2011
40 ACTIVE 1 NEJM 2011
41 ACTIVE 1 NEJM 2011
42 ACTIVE 1 NEJM 2011
43 NEJM 2011
44
45 ROADMAP NEJM 2011
46 ROADMAP - Occurrence of Microalbuminuria NEJM 2011
47 ROADMAP NEJM 2011
48 Cardiovascular Death Olmesartan and Cardiovascular Death Lessons from the ROADMAP and ORIENT Trials Roadmap Orient Olmesartan Placebo Olmesartan Placebo FDA 2010
49
50 Sartans may cause plaque rupture Strauss Circulation 2006
51
52 Discontinuation of study drugs in VALIANT NEJM 2003
53 Discontinuation of study drugs in VALIANT NEJM 2003
54 Discontinuation of study drugs in VALIANT NEJM 2003
55 Perception is reality
56
57 All-cause mortality reduction in trials with Perindopril (n= patients) n HR ASCOT-BPLA ( ), P=0.025 amlodipine/perindopril HYPERTENSIVES HYVET ( ), P=0.02 indapamide/perindopril OLD HYPERTENSIVES ADVANCE ( ), P=0.025 perindopril/indapamide DIABETICS Total ( ) Active better Control better 0,5 0,75 1 1,25 1,5, P<0.001
58 ACS: The Golden Rules of Hypertension ACE-Inhibitor or Sartan if ACE-I is not tolerated Ca-Antagonist Statin
59 Merci Frank Ruschitzka, MD, FRCP, FESC Professor of Cardiology University Hospital Zürich, Switzerland
60 Chutzpah The ARB a tale of overmarketing traditionally defined by the example of the young man who kills his parents, then pleads for mercy because he s an orphan PAUL KRUGMAN
61 Sartans - selective PPAR modulators Schupp Diabetes 2006
62 Telmisartan or TelmiGlitazone
63 Who tried to kill Bill?
64
65
66 Cardiovascular Risk Stratification Absolute risk in % of a fatal or non-fatal myocardial infarction or stroke over 10 years High Risk >20% 10-Jahresrisiko: >20% Intermediate Risk 10-20% 10-Jahresrisiko: 10 bis 20% Low Risk <10% 10-Jahresrisiko: <10% 28% 4%
67 Stratification of Risk to Quantify Prognosis
68 How would you treat Bill?
ACE inhibitors: still the gold standard?
ACE inhibitors: still the gold standard? Session: Twenty-five years after CONSENSUS What have we learnt about the RAAS in heart failure? Lars Køber, MD, D.Sci Department of Cardiology Rigshospitalet University
More informationOptimal blockade of the Renin- Angiotensin-Aldosterone. in chronic heart failure
Optimal blockade of the Renin- Angiotensin-Aldosterone Aldosterone- (RAA)-System in chronic heart failure Jan Östergren Department of Medicine Karolinska University Hospital Stockholm, Sweden Key Issues
More informationShould All Patients Be Treated with Ace-inh /ARB after STEMI with Preserved LV Function?
Should All Patients Be Treated with Ace-inh /ARB after STEMI with Preserved LV Function? Avi Shimony, MD, FESC Cardiology Division Soroka University Medical Center Ben-Gurion University, Beer-Sheva Disclosure
More informationheart failure John McMurray University of Glasgow.
A to Z of RAAS blockade in heart failure John McMurray BHF Cardiovascular Research Centre University of Glasgow. RAAS inhibition in CHF ACE inhibition in patients with low LVEF CHF CONSENSUS Enalapril
More informationFerrari R, Fox K, Bertrand M, Mourad J.J, Akkerhuis KM, Van Vark L, Boersma E.
Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on cardiovascular mortality in hypertension: a meta-analysis of randomized controlled trials Ferrari R, Fox K, Bertrand
More informationVALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION
VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION Dr Catherine BESEME Paris 6 th December 2005 6 th International Congress of Bangladesh Society of Medicine Hypertension is a risk factor at the source, with
More informationUnderstanding and Development of New Therapies for Heart Failure - Lessons from Recent Clinical Trials -
Understanding and Development of New Therapies for Heart Failure - Lessons from Recent Clinical Trials - Clinical trials Evidence-based medicine, clinical practice Impact upon Understanding pathophysiology
More informationScientific conclusions and detailed explanation of the scientific grounds for the differences from the PRAC recommendation
Annex I Scientific conclusions, grounds for variation to the terms of the marketing authorisations and detailed explanation of the scientific grounds for the differences from the PRAC recommendation 1
More informationRAS Blockade Across the CV Continuum
A Summary of Recent International Meetings RAS Blockade Across the CV Continuum Copyright New Evidence Presented at the 2009 Congress of the European Society of Cardiology (August 29-September 2, Barcelona)
More informationCombination of renin-angiotensinaldosterone. how to choose?
Combination of renin-angiotensinaldosterone system inhibitors how to choose? Karl Swedberg Professor of Medicine Sahlgrenska Academy University of Gothenburg karl.swedberg@gu.se Disclosures Research grants
More informationESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure
ESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure - 2005 Karl Swedberg Professor of Medicine Department of Medicine Sahlgrenska University Hospital/Östra Göteborg University Göteborg
More informationState of the art treatment of hypertension: established and new drugs. Prof. M. Burnier Service of Nephrology and Hypertension Lausanne, Switzerland
State of the art treatment of hypertension: established and new drugs Prof. M. Burnier Service of Nephrology and Hypertension Lausanne, Switzerland First line therapies in hypertension ACE inhibitors AT
More informationBLOOD PRESSURE-LOWERING TREATMENT
BLOOD PRESSURE-LOWERING TRIALS NUMBER OF PARTICIPANTS NUMBER OF PERCENTAGE OF MEAN AGE MEAN - (YEARS) TRIALS WITH ANALYSIS BY GENDER N, (%) 69,473 28,008 40.3% 70.2 3.2 3/5 (60%) APPENDIX 2 1 BLOOD PRESSURE-LOWERING
More informationNew Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids.
PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Disclosure No relevant
More informationOutcomes and Perspectives of Single-Pill Combination Therapy for the modern management of hypertension
Outcomes and Perspectives of Single-Pill Combination Therapy for the modern management of hypertension Prof. Massimo Volpe, MD, FAHA, FESC, Chair of Cardiology, Department of Clinical and Molecular Medicine
More informationHypertension Update 2009
Hypertension Update 2009 New Drugs, New Goals, New Approaches, New Lessons from Clinical Trials Timothy C Fagan, MD, FACP Professor Emeritus University of Arizona New Drugs Direct Renin Inhibitors Endothelin
More informationCardiac Protection across the cardiac continuum. Dong-Ju Choi, MD, PhD College of Medicine Seoul National University
Cardiac Protection across the cardiac continuum Dong-Ju Choi, MD, PhD College of Medicine Seoul National University Renin Angiotensin Cascade Nitric oxide (NO) Bradykinin Degradation products ACE ACEI
More informationT. Suithichaiyakul Cardiomed Chula
T. Suithichaiyakul Cardiomed Chula The cardiovascular (CV) continuum: role of risk factors Endothelial Dysfunction Atherosclerosis and left ventricular hypertrophy Myocardial infarction & stroke Endothelial
More informationANGIOTENSIN II RECEPTOR BLOCKERS: MORE THAN THE ALTERNATIVE PRESENTATION BY: PATRICK HO, USC PHARM D. CANDIDATE OF 2017 MENTOR: DR.
ANGIOTENSIN II RECEPTOR BLOCKERS: MORE THAN THE ALTERNATIVE PRESENTATION BY: PATRICK HO, USC PHARM D. CANDIDATE OF 2017 MENTOR: DR. CRAIG STERN, PHARMD, MBA, RPH, FASCP, FASHP, FICA, FLMI, FAMCP RENIN-ANGIOTENSIN
More informationThe Beneficial Role of Angiotensin- Converting Enzyme Inhibitor in Acute Myocardial Infarction
The Beneficial Role of Angiotensin- Converting Enzyme Inhibitor in Acute Myocardial Infarction Cardiovascular Center, Korea University Guro Hospital 2007. 4. 20 Seung-Woon Rha, MD, PhD Introduction 1.
More informationAre all Antihypertensives the same?
Are all Antihypertensives the same? Athanasios J. Manolis MD, FACC, FESC, FAHA Director of Cardiology Dept, Asklepeion General Hospital, Athens Greece. Adj. Ass. Professor, Hypertension Section, Boston
More informationBeta-blockers: Now what? Annemarie Thompson, MD Assistant Professor of Anesthesia and Medicine Vanderbilt University Medical Center
Beta-blockers: Now what? Annemarie Thompson, MD Assistant Professor of Anesthesia and Medicine Vanderbilt University Medical Center Beta-blockers: What s known 30 Years 30 Careers Physician clarity regarding
More informationModern Management of Hypertension
Modern Management of Hypertension Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Current Status of Hypertension Prevalence
More informationTherapeutic Targets and Interventions
Therapeutic Targets and Interventions Ali Valika, MD, FACC Advanced Heart Failure and Pulmonary Hypertension Advocate Medical Group Midwest Heart Foundation Disclosures: 1. Novartis: Speaker Honorarium
More informationAngiotensin Receptor Blockers: Novel Role in High-Risk Patients
Angiotensin Receptor Blockers: Novel Role in High-Risk Patients UsmanJaved, MD a, Prakash C. Deedwania, MD, FACC, FACP, FCCP, FAHA a,b, * KEYWORDS Angiotensin receptor blockers RAAS blockade Cardioprotection
More informationPreventing and Treating High Blood Pressure
Preventing and Treating High Blood Pressure: Finding the Right Balance of Integrative and Pharmacologic Approaches Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Blood Pressure
More informationEntresto Development of sacubitril/valsartan (LCZ696) for the treatment of heart failure with reduced ejection fraction
Cardio-Metabolic Franchise Entresto Development of sacubitril/valsartan (LCZ696) for the treatment of heart failure with reduced ejection fraction Randy L Webb, PhD Rutgers Workshop October 21, 2016 Heart
More informationA Fresh Look at ARBs : Focus on HF survival data
A Fresh Look at ARBs : Focus on HF survival data Seok-Min Kang, MD, Ph D. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea HF specialists ARBs,
More informationFaiez Zannad. Institut Lorrain du Coeur et des Vaisseaux. CIC - Inserm
Faiez Zannad Institut Lorrain du Coeur et des Vaisseaux CIC - Inserm Disclosure Faiez Zannad Grants BG Medicine, Roche Diagnostics. Consultant/Steering committees/event committees/ Data safety Monitoring
More informationClinical cases with Coversyl 10 mg
Clinical cases Coversyl 10 mg For upgraded benefits in hypertension A Editorial This brochure, Clinical cases Coversyl 10 mg for upgraded benefits in hypertension, illustrates a variety of hypertensive
More informationUpdate on pharmacological treatment of heart failure. Aldo Pietro Maggioni, MD, FESC ANMCO Research Center Firenze, Italy
Update on pharmacological treatment of heart failure Aldo Pietro Maggioni, MD, FESC ANMCO Research Center Firenze, Italy Presenter Disclosures Dr. Maggioni : Serving in Committees of studies sponsored
More informationScientific conclusions and detailed explanation of the scientific grounds for the differences from the PRAC recommendation
Annex I Scientific conclusions, grounds for variation to the terms of the marketing authorisations and detailed explanation of the scientific grounds for the differences from the PRAC recommendation 1
More informationDrugs acting on the reninangiotensin-aldosterone
Drugs acting on the reninangiotensin-aldosterone system John McMurray Eugene Braunwald Scholar in Cardiovascular Diseases, Brigham and Women s Hospital, Boston & Visiting Professor, Harvard Medical School
More informationHow clinically important are the results of the large trials in hypertension?
How clinically important are the results of the large trials in hypertension? Stéphane LAURENT, MD, PhD, FESC Pharmacology Department and PARCC / INSERM U970 Hôpital Européen Georges Pompidou, Université
More informationJoo-Yong Hahn, MD/PhD
Sungkyunkwan University School of Medicine Joo-Yong Hahn, MD/PhD Heart Vascular Stork Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Grant support Korean Society of Interventional
More informationSafety of Lipid-lowering Drugs Frank Ruschitzka, MD, FRCP Professor of Cardiology Head, Heart Failure/Transplantation University Clinic Zurich
Safety of Lipid-lowering Drugs Frank Ruschitzka, MD, FRCP Professor of Cardiology Head, Heart Failure/Transplantation University Clinic Zurich Conflict of interest: Bayer, Biomarin, Biotronik, Cardiorentis,
More informationACP Brief Fall 2006 prioritization. Angiotensin II Receptor Blockers (ARBs) for Proteinuria, Hypertension (HTN) and Congestive Heart Failure (CHF)
ACP Brief Fall 2006 prioritization Angiotensin II Receptor Blockers (ARBs) for Proteinuria, Hypertension (HTN) and Congestive Heart Failure (CHF) Background This topic was submitted by BC PharmaCare during
More informationModern Management of Hypertension: Where Do We Draw the Line?
Modern Management of Hypertension: Where Do We Draw the Line? Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Blood Pressure
More informationAPPENDIX D: PHARMACOTYHERAPY EVIDENCE
Página 1 de 7 APPENDIX D: PHARMACOTYHERAPY EVIDENCE Table D1. Outcome Trials of Antihypertensive Agents Study Drug Regimen N Duration Primary Outcomes Remarks Antihypertensive Therapy vs Placebo SHEP 1991
More informationTreatment to reduce cardiovascular risk: multifactorial management
Treatment to reduce cardiovascular risk: multifactorial management Matteo Anselmino, MD PhD Assistant Professor San Giovanni Battista Hospital Division of Cardiology, Department of Internal Medicine University
More informationThe Road to Renin System Optimization: Renin Inhibitor
The Road to Renin System Optimization: Renin Inhibitor A New Perspective on the Renin-Angiotensin System (RAS) Yong-Jin Kim, MD Seoul National University Hospital Human and Economic Costs of Hypertension
More informationThe role of angiotensin II receptor blockers in the management of heart failure
European Heart Journal Supplements (2005) 7 (Supplement J), J10 J14 doi:10.1093/eurheartj/sui057 The role of angiotensin II receptor blockers in the management of heart failure John J.V. McMurray* Department
More informationANGIOTENSIN-CONVERTING
BRIEF REPORT Impact of on Nonfatal Myocardial Infarction and Cardiovascular Death in Patients With Heart Failure Catherine Demers, MD, MSc John J. V. McMurray, MD Karl Swedberg, MD, PhD Marc A. Pfeffer,
More informationManagement of The Patients with Hypertension and High Risk Cardiovascular Disease
Management of The Patients with Hypertension and High Risk Cardiovascular Disease Songsak Kiatchoosakun, MD. Cardiology, Medicine Khon Kaen University CVD and Hypertension: Worldwide Morbidity and Mortality
More informationHypertension Update Clinical Controversies Regarding Age and Race
Hypertension Update Clinical Controversies Regarding Age and Race Allison Helmer, PharmD, BCACP Assistant Clinical Professor Auburn University Harrison School of Pharmacy July 22, 2017 DISCLOSURE/CONFLICT
More informationESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure
Patients t with acute heart failure frequently develop chronic heart failure Patients with chronic heart failure frequently decompensate acutely ESC Guidelines for the Diagnosis and A clinical response
More informationManaging Hypertension in 2016
Managing Hypertension in 2016: Where Do We Draw the Line? Disclosure No relevant financial relationships Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine baron@medicine.ucsf.edu
More informationJNC 8 -Controversies. Sagren Naidoo Nephrologist CMJAH
JNC 8 -Controversies Sagren Naidoo Nephrologist CMJAH Joint National Committee (JNC) Panel appointed by the National Heart, Lung, and Blood Institute (NHLBI) First guidelines (JNC-1) published in 1977
More informationManagement of Lipid Disorders and Hypertension: Implications of the New Guidelines
Management of Lipid Disorders and Hypertension Management of Lipid Disorders and Hypertension: Implications of the New Guidelines Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine
More informationHeart Failure Treatments
Heart Failure Treatments Past & Present www.philippelefevre.com Background Background Chronic heart failure Drugs Mechanical Electrical Background Chronic heart failure Drugs Mechanical Electrical Sudden
More informationDisclosure of Relationships
Disclosure of Relationships Over the past 12 months Dr Ruilope has served as Consultant and Speakers Bureau member of Astra-Zeneca, Bayer, Daiichi-Sankyo, Menarini, Novartis, Otsuka, Pfizer, Relypsa, Servier
More informationMANAGEMENT OF HYPERTENSION: TREATMENT THRESHOLDS AND MEDICATION SELECTION
Management of Hypertension: Treatment Thresholds and Medication Selection Robert B. Baron, MD MS Professor and Associate Dean Declaration of full disclosure: No conflict of interest Presentation Goals
More informationEffect on sudden death
Effect on sudden death of heart failure treatment started with bisoprolol followed by enalapril, compared to the opposite order: Results of the randomized CIBIS III trial Ronnie Willenheimer Ass. Prof.
More informationUse of Sacubitril/Valsartan in Heart Failure
Use of Sacubitril/Valsartan in Heart Failure & the PARADIGM-HF trial Sarah Mackenzie, PharmD student, University of Toronto Presentation Outline Overview of: Entresto PARADIGM-HF trial Critical Appraisal
More informationARBs in Cardiovascular Disease
ARBs in Cardiovascular Disease Yong-Jin Kim, MD Seoul National University Hospital Cardiovascular Continuum Ventricular remodelling Remodelling Myocardial infarction Myocardial infarction Ventricular dilation
More informationACEIs for cardiovascular risk reduction
clinical Andrew Sindone Jonathan Erlich Vlado Perkovic Michael Suranyi Henry Newman Choon Lee Edward Barin Simon D Roger ACEIs for cardiovascular risk reduction Have we taken our eye off the ball? Background
More informationADVANCES IN MANAGEMENT OF HYPERTENSION
Advances in Management of Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Current Status of Prevalence 29%; Blacks 33.5%
More informationUpdate in Hypertension
Update in Hypertension Eliseo J. PérezP rez-stable MD Professor of Medicine DGIM, Department of Medicine UCSF 20 May 2008 Declaration of full disclosure: No conflict of interest (I have never been funded
More informationLXIV: DRUGS: 4. RAS BLOCKADE
LXIV: DRUGS: 4. RAS BLOCKADE ACE Inhibitors Components of RAS Actions of Angiotensin i II Indications for ACEIs Contraindications RAS blockade in hypertension RAS blockade in CAD RAS blockade in HF Limitations
More informationI know the trials in heart failure but how do I manage my patient? Dosing of neurohormones antagonists
I know the trials in heart failure but how do I manage my patient? Dosing of neurohormones antagonists Alessandro Fucili (Ferrara, IT) Massimo F Piepoli (Piacenza, IT) Clinical Case: 82 year old woman
More informationFactors Involved in Poor Control of Risk Factors
Factors Involved in Poor Control of Risk Factors Patient compliance Clinical inertia Health Care System structure 14781 M Limitations of Formal Studies Selection of patients Recruitment and follow-up alter
More informationBlood Pressure Targets: Where are We Now?
Blood Pressure Targets: Where are We Now? Diana Cao, PharmD, BCPS-AQ Cardiology Assistant Professor Department of Clinical & Administrative Sciences California Northstate University College of Pharmacy
More informationNational Horizon Scanning Centre. Irbesartan (Aprovel) for heart failure with preserved systolic function. August 2008
Irbesartan (Aprovel) for heart failure with preserved systolic function August 2008 This technology summary is based on information available at the time of research and a limited literature search. It
More informationClinical and Economic Value of Rivaroxaban in Coronary Artery Disease
CHRISTOPHER B. GRANGER, MD Professor of Medicine Division of Cardiology, Department of Medicine; Director, Cardiac Care Unit Duke University Medical Center, Durham, NC Clinical and Economic Value of Rivaroxaban
More informationHypertension and diabetic nephropathy
Hypertension and diabetic nephropathy Elisabeth R. Mathiesen Professor, Chief Physician, Dr sci Dep. Of Endocrinology Rigshospitalet, University of Copenhagen Denmark Hypertension Brain Eye Heart Kidney
More informationIntroduction: Clinical Trials: Assessing Safety and Efficacy for a Diverse Population
Introduction: Clinical Trials: Assessing Safety and Efficacy for a Diverse Population FDA and JHU-CERSI White Oak, Maryland Wednesday, December 2, 2015 Keith C. Ferdinand, MD, FACC,FAHA,FNLA,FASH Professor
More informationMayo Clin Proc, March 2003, Vol 78 Role of ARBs in Treatment of Heart Failure 335 system, tissue-based RAS has long-term effects that can modify cardi
334 Concise Review for Clinicians Therapeutic Role of Angiotensin II Receptor Blockers in the Treatment of Heart Failure Concise Review for Clinicians PRERANA MANOHAR, MD, AND ILEANA L. PIÑA, MD Angiotensin
More informationManagement of Hypertension in Women
Management of Hypertension in Women Eliseo J. Pérez-Stable MD Professor of Medicine DGIM, Department of Medicine July 1, 2013 Declaration of full disclosure: No conflict of interest (I have never been
More informationMetabolic Consequences of Anti Hypertensives: Is It Clinically Important?
Metabolic Consequences of Anti Hypertensives: Is It Clinically Important?,FACA,FICA,MASH,FVBWG,MISCP CONSULTANT OF CARDIOLOGY DIRECTOR OF PORT-FOUAD HOSPITAL CCU Consideration of antihypertensive agents
More informationTop HF Trials to Impact Your Practice
Top HF Trials to Impact Your Practice Biykem Bozkurt, MD, FACC The Mary and Gordon Cain Chair & Professor of Medicine Medical Care Line Executive, DeBakey VA Medical Center, Director, Winters Center for
More informationDIASTOLIC HEART FAILURE
DIASTOLIC HEART FAILURE M Mohsen Ibrahim, MD Alexandria, Proposed Criteria for Diastolic Heart Failure ESC Working Group (EHJ 1998) CHF signs/symptoms EF 45% Hemodynamic or echo evidence of diastolic dysfunction
More informationA Meta-Analysis Reporting Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients Without Heart Failure
Journal of the American College of Cardiology Vol. 61, No. 2, 2013 2013 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2012.10.011
More informationCardiovascular Protection and the RAS
Cardiovascular Protection and the RAS Katalin Kauser, MD, PhD, DSc Senior Associate Director, Boehringer Ingelheim Pharmaceutical Inc. Micardis Product Pipeline Scientific Support Ridgefield, CT, USA Cardiovascular
More informationRole of Clopidogrel in Acute Coronary Syndromes. Hossam Kandil,, MD. Professor of Cardiology Cairo University
Role of Clopidogrel in Acute Coronary Syndromes Hossam Kandil,, MD Professor of Cardiology Cairo University ACS Treatment Strategies Reperfusion/Revascularization Therapy Thrombolysis PCI (with/ without
More informationTreating Hypertension in Individuals with Diabetes
Treating Hypertension in Individuals with Diabetes Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or by any
More informationANTIPAF Angiotensin II Antagonist in Paroxysmal Atrial Fibrillation Trial
European Society of Cardiology Hotline Stockholm - Zone K 31 st August 2010 Placebo ARB Kumagai K, et al. JACC 2003 Discussant ANTIPAF Angiotensin II Antagonist in Paroxysmal Atrial Fibrillation Trial
More informationTHE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM
THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM The renin angiotensin system (RAS) or the renin angiotensin aldosterone system (RAAS) is a hormone system that is involved in the regulation of the plasma sodium
More informationVolume 6; Number 1 January 2012 NICE CLINICAL GUIDELINE 127: HYPERTENSION CLINICAL MANAGEMENT OF PRIMARY HYPERTENSION IN ADULTS (AUGUST 2011)
Volume 6; Number 1 January 2012 NICE CLINICAL GUIDELINE 127: HYPERTENSION CLINICAL MANAGEMENT OF PRIMARY HYPERTENSION IN ADULTS (AUGUST 2011) What s new in hypertension? NICE has issued an updated Clinical
More information2/17/2010. Grace Lin, MD Assistant Professor of Medicine University of California, San Francisco
Modern Management of Patients with Stable Coronary Artery Disease Grace Lin, MD Assistant Professor of Medicine University of California, San Francisco Scope of the Problem Prevalence of CAD: 17.6 million
More informationIs Heart Rate a Treatment Target?
Is Heart Rate a Treatment Target? M. Böhm Innere Medizin III (Kardiologie / Angiologie / Internistische Intensivmedizin) Universitätsklinikum des Saarlandes Homburg/Saar michael.boehm@uks.eu Heart Rate
More informationHFpEF, Mito or Realidad?
HFpEF, Mito or Realidad? Ileana L. Piña, MD, MPH Professor of Medicine and Epidemiology/Population Health Associate Chief for Academic Affairs -- Cardiology Montefiore-Einstein Medical Center Bronx, NY
More informationThis clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.
abcd Clinical Study Synopsis for Public Disclosure This clinical study synopsis is provided in line with s Policy on Transparency and Publication of Clinical Study Data. The synopsis which is part of the
More informationBeta-blockers in Patients with Mid-range Left Ventricular Ejection Fraction after AMI Improved Clinical Outcomes
Beta-blockers in Patients with Mid-range Left Ventricular Ejection Fraction after AMI Improved Clinical Outcomes Seung-Jae Joo and other KAMIR-NIH investigators Department of Cardiology, Jeju National
More informationThe Therapeutic Potential of Novel Approaches to RAAS. Professor of Medicine University of California, San Diego
The Therapeutic Potential of Novel Approaches to RAAS Inhibition in Heart Failure Barry Greenberg, M.D. Professor of Medicine University of California, San Diego Chain of Events Leading to End-Stage Heart
More informationHeart Failure: Current Management Strategies
Heart Failure: Current Management Strategies CSHP Fall Education Session- September 30th, 2017 Carolyn MacKinnon & Tamara Matchett BscPharm, ACPR Candidates Objectives 1. Describe the pathophysiology &
More informationCedars Sinai Diabetes. Michael A. Weber
Cedars Sinai Diabetes Michael A. Weber Speaker Disclosures I disclose that I am a Consultant for: Ablative Solutions, Boston Scientific, Boehringer Ingelheim, Eli Lilly, Forest, Medtronics, Novartis, ReCor
More informationManagement of Hypertension
Clinical Practice Guidelines Management of Hypertension Definition and classification of blood pressure levels (mmhg) Category Systolic Diastolic Normal
More informationHypertension Management Focus on new RAAS blocker. Disclosure
Hypertension Management Focus on new RAAS blocker Rameshkumar Raman M.D Endocrine Associates of The Quad Cities Disclosure Speaker bureau Abbott, Eli Lilly, Novo Nordisk, Novartis, Takeda, Merck, Solvay
More informationThe State of Hypertension in NZ in 2010 personal view
The State of Hypertension in NZ in 2010 personal view Patient referred to medical clinic Dear Dr, Please see this man with resistant hypertension 50 year old European male Blood Pressure on current meds
More informationNew evidences in heart failure: the GISSI-HF trial. Aldo P Maggioni, MD ANMCO Research Center Firenze, Italy
New evidences in heart failure: the GISSI-HF trial Aldo P Maggioni, MD ANMCO Research Center Firenze, Italy % Improving survival in chronic HF and LV systolic dysfunction: 1 year all-cause mortality 20
More informationIntroductory Clinical Pharmacology Chapter 41 Antihypertensive Drugs
Introductory Clinical Pharmacology Chapter 41 Antihypertensive Drugs Blood Pressure Normal = sys
More informationADVANCES IN MANAGEMENT OF HYPERTENSION
Prevalence 29%; Blacks 33.5% About 72.5% treated; 53.5% uncontrolled (>140/90) Risk for poor control: Latinos, Blacks, age 18-44 and 80,
More informationEjection Fraction in Patients With Chronic Heart Failure. Diastolic Heart Failure or Heart Failure with Preserved Ejection Fraction
Diastolic Heart Failure or Heart Failure with Preserved Ejection Fraction Keith Miller MD Diastolic Heart Failure Risk Factors Common Risk Factors Aging Female gender Obesity Hypertension Diabetes mellitus
More informationHTN: 80 mg once daily 23,f 80 mg once daily 23,f Hypertension 40, 80 mg $82.66 (80 mg once daily) HTN: 8-32 mg daily in one or two divided doses 1
Detail-Document #260301 This Detail-Document accompanies the related article published in PHARMACIST S LETTER / PRESCRIBER S LETTER March 2010 ~ Volume 26 ~ Number 260301 Comparison of Angiotensin Receptor
More informationTreating Hypertension in 2018: What Makes the Most Sense Today?
Treating Hypertension in 2018: What Makes the Most Sense Today? Daniel Blanchard, MD Professor of Medicine UC San Diego Cardiovascular Center La Jolla, California 1 2 Speaker Disclosures Consultant and/or
More informationNew Antihypertensive Strategies to Improve Blood Pressure Control
New Antihypertensive Strategies to Improve Blood Pressure Control Antonio Coca, MD, PhD,, FRCP, FESC Hypertension and Vascular Risk Unit Department of Internal Medicine. Hospital Clínic (IDIBAPS) University
More informationTreating HF Patients with ARNI s Why, When and How?
Treating HF Patients with ARNI s Why, When and How? 19 th Annual San Diego Heart Failure Symposium for Primary Care Physicians January 11-12, 2019 La Jolla, CA Barry Greenberg M.D. Distinguished Professor
More informationHypertension Update Warwick Jaffe Interventional Cardiologist Ascot Hospital
Hypertension Update 2008 Warwick Jaffe Interventional Cardiologist Ascot Hospital Definition of Hypertension Continuous variable At some point the risk becomes high enough to justify treatment Treatment
More informationSacubitril/Valsartan in HFrEF for All Protagonist View George Honos MD FRCPC FCCS FACC
Sacubitril/Valsartan in HFrEF for All Protagonist View George Honos MD FRCPC FCCS FACC Head of Cardiology Medical Manager / CV Program CHUM Disclosure Statement Within the past two years: I have had an
More informationThe Clinical Unmet need in the patient with Diabetes and ACS
The Clinical Unmet need in the patient with Diabetes and ACS Professor Kausik Ray (UK) BSc(hons), MBChB, MD, MPhil, FRCP (lon), FRCP (ed), FACC, FESC, FAHA Diabetes is a global public health challenge
More information