Prevention of Atrial Fibrillation and Heart Failure in the Hypertensive Patient
|
|
- Whitney Terry
- 5 years ago
- Views:
Transcription
1 Prevention of Atrial Fibrillation and Heart Failure in the Hypertensive Patient The Issue of Primary Prevention of A.Fib. (and Heart Failure) and not the Prevention of Recurrent A.Fib. after Electroconversion or Treatment of Patients With Established Heart Disease Prof. Sverre E. Kjeldsen, MD, PhD Department of Cardiology, Oslo University Hospital, Ullevaal, Oslo, Norway
2 Prevalence of HT in AF Trials Manolis AJ et al. ESH Position Paper. J Hypertens 2011; 30:
3 Kaplan-Meier Curves Showing Participants Free From AF Related to Quartiles of Systolic BP (N=2014) N=272 detected with new onset atrial fibrillation. 100% 90% Free from atrial fibrillation 80% 70% 60% Q1 (88-116) Q2 ( ) Q3 ( ) Q4 ( ) Observation time (Years) High normal SBP predicts incident atrial fibrillation Grundvold I, Kjeldsen SE et al. J Hypertension 2012; 59:
4 Diuretic and beta-blocker treatment mainly Prevention of Heart Failure and LVH in Hypertension Strongly Suggests Similar Prevention of Atrial Fibrillation 4
5 Possible Preventive Mechanisms of ARBs in Atrial Fibrillation Aksnes TA, Flaa A, Strand A, Kjeldsen SE. J Hypertens 2007;25:15-23
6
7 Prevention of Atrial Fibrillation by RAAS-Inhibtion (JACC 2010) Study Treatment Control OR (random) Weight OR (random) or sub-category n/n n/n 95% CI % 95% CI Hypertension studies Hansson (CAPPP) 117/ / [0.67, 1.11] Hansson (STOP-2) 200/ / [0.95, 1.37] Wachtell (LIFE) 150/ / [0.52, 0.80] Salehian (HOPE) 86/ / [0.66, 1.20] Schmieder (VALUE) 252/ / [0.71, 1.00] Yusuf (TRANSCEND) 182/ / [0.82, 1.26] Subtotal (95% CI) [0.75, 1.05] Total events: 987 (Treatment), 1283 (Control) Test for heterogeneity: Chi² = 17.98, df = 5 (P = 0.003), I² = 72.2% Test for overall effect: Z = 1.39 (P = 0.17) Post-MI studies Pedersen (TRACE) 22/790 42/ [0.30, 0.86] Pizzetti (GISSI-3) 665/ / [0.82, 1.02] Subtotal (95% CI) [0.41, 1.27] Total events: 687 (Treatment), 763 (Control) Test for heterogeneity: Chi² = 4.59, df = 1 (P = 0.03), I² = 78.2% Test for overall effect: Z = 1.13 (P = 0.26) Heart Failure studies Vermes (SOLVD) 10/186 45/ [0.09, 0.37] Ducharme (CHARM) 177/ / [0.66, 1.00] Maggioni (Val-HeFT) 113/ / [0.49, 0.80] Subtotal (95% CI) [0.31, 0.87] Total events: 300 (Treatment), 434 (Control) Test for heterogeneity: Chi² = 16.40, df = 2 (P = ), I² = 87.8% Test for overall effect: Z = 2.48 (P = 0.01) Post-cardioversion studies Van den Berg 2/7 7/ [0.03, 1.77] Madrid 9/79 22/ [0.13, 0.73] Ueng 18/70 32/ [0.23, 0.94] Madrid 2 8/30 14/ [0.14, 1.23] Grecu 10/16 16/ [0.09, 1.85] Tveit 48/68 45/ [0.62, 2.63] Belluzzi 3/31 10/ [0.06, 0.92] GISSI-AF CAPPP adverse 371/722 event 375/720 reports [0.79, 1.20] Subtotal (95% CI) [0.34, 0.89] Total events: 469 (Treatment), 521 (Control) Test for heterogeneity: Chi² = 18.59, df = 7 (P = 0.010), I² = 62.3% Test for overall effect: Z = 2.44 (P = 0.01) STOP-2 adverse event reports LIFE secondary endpoint and annual ECGs first HT study Medical Therapy studies Yin 25/118 24/ [0.20, 0.78] Fogari 1 13/111 39/ [0.12, 0.49] Fogari 2 42/246 46/ [0.21, 0.56] Fogari 3 28/148 48/ [0.28, 0.83] Subtotal HOPE (95% CI) not a hypertension study [0.27, 0.49] Total events: 108 (Treatment), 157 (Control) Test for heterogeneity: Chi² = 2.45, df = 3 (P = 0.49), I² = 0% Test for overall effect: Z = 6.73 (P < ) VALUE secondary endpoint and annual ECGs second HT study TRANSCEND not a hypertension study Total (95% CI) [0.57, 0.78] Total events: 2551 (Treatment), 3158 (Control) Test for heterogeneity: Chi² = , df = 22 (P < ), I² = 78.2% Test for overall effect: Z = 5.24 (P < ) Favours treatment Favours control
8 Primary Prevention of Atrial Fibrillation in the Treatment of Hypertension Need hypertensive population with high risk of incidental atrial fibrillation Need pre-specified protocol Need AF detection from systematic taking of ECGs and central ECG readings Need double-blinded head-to-head randomized comparison Two trials fullfil these criteria LIFE and VALUE
9 LIFE Baseline Characteristics-1 n=9193 Age, years 66.9 (7.0) Female, n 4963 (54%) Body mass index, kg/m (4.8) Blood pressure, mmhg 174.4/97.8 (14.3/8.9) Heart rate, bpm 73.8 (11.1) Cornell product, mm msec (1049.5) Sokolow-Lyon, mm 30.0 (10.5) Framingham risk score (0.096) Smokers, n 1499 (16%) Values are mean (SD) or n (%) when indicated.
10
11 LIFE: Patient Recruitment ECG-Criterion (n=9192) Sokolow-Lyon 22 % Both 10 % Cornell Product 68 % Dahlöf B, Kjeldsen SE et al. Hypertension 1998;32:
12
13 LIFE Atrial Fibrillation: Losartan vs. Atenolol Reduces New Onset AF/Flutter Proportion of patients with first event (%) RR: 0.70 [95% CI: ], p< Time (months) Losartan Atenolol Wachtell, Kjeldsen SE et al.: J Am Coll Cardiol 2005;45:
14 LIFE Atrial Fibrillation: Stroke in Patients with and without AF Strokes in Losartan-Treated Patients Strokes in Atenolol-Treated Patients Hazard Ratio (95% CI) Patients with Pre-existing AF (n=342) ( ) p=0.039 Patients with New-onset AF (n=371) (n=150 with new AF) (n=221 with new AF) ( ) p=0.01 Patients with No AF (n=8480) ( ) p=0.04 Wachtell K, Kjeldsen SE et al.: J Am Coll Cardiol 2005;45: and
15 Circ Arrhythm Electrophysiol 2013;6:
16 Regression of Cornell Product LVH with Losartan vs Atenolol Treatment 0 6 Months 1-Year 2-Year 3-Year 4-Year 5-Year Last Cornell Product (mm msec) p< p< p< p< p< p< p< Dahlöf B, Devereux RB, Kjeldsen SE et al. Lancet Losartan Atenolol
17 New Onset of AF According to the Presence or Absence of ECG LVH by Time-Varying Cornell Voltage-Duration Product 0.09 <= 2440 (n=2931, 3950, 3832) >2440 (n=5604, 4156, 3641) 0.08 New-Onset AF Rate Adapted from Okin et al.: JAMA 2006;296: Follow-Up (Months) * n= number of patients in each group at baseline, 2 and 4 years of LIFE 23
18 Incidence of Atrial Fibrillation in Relation to Changing Heart Rate Over Time in Hypertensive Patients. The LIFE Study. Okin PM, Wachtell K, Kjeldsen SE et al. Circ Arrhythmia Electrophysiol 2008; 1:
19 HF: Framingham Criteria Major Criteria Clinical Findings Diagnostic Findings Minor Criteria* Clinical Findings Diagnostic Findings Minimum requirement 2 major findings, or 1 major finding plus 2 minor findings In both cases at least 1 clinical finding, and 1 diagnostic finding * Minor findings are accepted only if they cannot be attributed to another disease process
20 MAJOR CRITERIA LIFE: Criteria for Heart Failure CLINICAL Paroxysmal nocturnal dyspnea or orthopnea Jugular venous distention Pulmonary rales Ventricular S 3 gallop Hepatojugular reflux Diuresis 10 lbs/5kg in response to diuretic; clinical improvement in congestive symptoms DIAGNOSTIC Acute pulmonary edema on chest x-ray PCWP 20 mmhg LVEF 35 CI < 2,0 Evidence of severe valvular heart disease Pulmonary edema or visceral congestion on autopsy MINOR CRITERIA* FINDINGS Night cough Dyspnea on ordinary exertion Bilateral ankle edema Hepatomegaly FINDINGS Pleural effusion or pulmonary vascular engorgement or redistribution on x-ray PCWP mmhg LVEF CI 2,0 2,4 Evidence of moderate valvular heart disease * Minor criteria will be accepted only if they can not be attributed to another disease process
21 147:
22 * 147:
23 Electrocardiographic Strain Pattern and Prediction of New-Onset Congestive Heart Failure in Hypertensive Patients: The LIFE Study Okin P, Kjeldsen SE et al. Circ 2006; 113:
24 Okin P, Kjeldsen SE et al. Circ 2009; 119:
25 Pulse Pressure and Incident Atrial Fibrillation in LIFE Larstorp AC, Kjeldsen SE et al. Hypertension 2012; 60:
26 Hypertension 2015; 66:
27 Summary New Atrial Fibrillation in LIFE 1) LIFE included n=9193 patients with ECG-LVH 2) In LIFE, losartan reduced new AF with 30% compared to atenolol 3) In LIFE, regression of ECG-LVH was strongly related to less new AF. Lower heart rate was also related to less new AF suggesting HR lowering therapy (ivabradin study) 4) In LIFE, prevention of new AF was related to less stroke 5) In LIFE, new AF predicted sudden cardiac death and incident heart failure 6) In LIFE, baseline BP predicts new AF despite treatment and lower achieved BP (in-treatment BP) gives less AF 27
28 VALUE: Patient Characteristics Associated Risk Factors Associated Diseases Increased serum creatinine 3.6 LVH with Strain 6.1 LVH Proteinuria PAD 13.9 Active smoker 24.0 Stroke 19.8 Diabetes 31.6 High Cholesterol 33.3 CAD Patients (%) LVH = left ventricular hypertrophy. PAD = peripheral artery disease; CAD = coronary artery disease. Kjeldsen SE, Julius S et al. Blood Press. 2001;10: Patients (%)
29
30
31 Reduced First Occurence of Incident Atrial Fibrillation With ARB: the VALUE Trial Schmieder RE, Kjeldsen SE, Julius SE et al. J Hypertens 2008; 26:
32 Reduced First Occurence of Persistent Atrial Fibrillation With ARB: the VALUE Trial Schmieder RE, Kjeldsen SE, Julius SE et al. J Hypertens 2008; 26:
33 Importance of Incident Atrial Fibrillation for Primary Cardiac Endpoint: the VALUE Trial Schmieder RE, Kjeldsen SE, Julius SE et al. J Hypertens 2008; 26:
34 VALUE: Baseline Characteristics Aksnes TA, Kjeldsen SE, et al. Hypertension 2007; 50: Never DM (8697) New-onset DM (1298) Baseline DM (5250) Age (years) 67.5 ± ± ± 7.9 Gender (% male) 57.8 % 63.1% 55.9%* Caucasian 91.8 % 86.8 % 85.9 % BMI (kg/m²) 27.7 ± ± ± 5.4 SBP (mmhg) ± ± ± 18.9 DBP (mmhg) 87.8 ± ± ± 10.8 HR (bpm) 71.1 ± ± ± 10.8 Glucose (mmol/l) 5.38 ± ± ± 3.26 Potassium (mmol/l) 4.36 ± ± ± 0.46 Pair-wise comparison with never DM; *0.01 p-value<0.05, p-value<0.01, p-value <0.0001
35
36
37 Patients Developing Atrial Fibrillation Have More Heart Failure Heart failure (%) 20 No Atrial Fibrillation New Atrial Fibrillation Aksnes TA, Kjeldsen SE et al. Am J Cardiol 2008; 101: Never DM New-onset DM Baseline DM
38 Obesity Diabetes LVH Diastolic dysfunction BP Atrial Fibrillation HEART FAILURE Myocardial ischemia Systolic dysfunction
39
40 2013 ESH/ESC Hypertension Guidelines
41 ACEI ARB BB* MRA* CCB Diuretic HYPERTENSION ATRIAL FIBRILLATION
ALLHAT. U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung, and Blood Institute
U.S. Department of Health and Human Services National Institutes of Health National Heart, Lung, and Blood Institute Review of Heart Failure Events in the Antihypertensive and Lipid Lowering Treatment
More informationΗ θέση της αντισπερτασικής αγωγής στην πρόληψη της κολπικής μαρμαρσγής. Ανδρέας Πιηηαράς. Σεμινάριο ΟΕ ΕΚΕ Θεζζαλονίκη 2012
Η θέση της αντισπερτασικής αγωγής στην πρόληψη της κολπικής μαρμαρσγής Ανδρέας Πιηηαράς Σεμινάριο ΟΕ ΕΚΕ Θεζζαλονίκη 2012 AF May Present with a Wide Range of Symptoms LIGHT- HEADEDNESS PALPITATIONS SYNCOPE
More informationThe Role of ACEI and ARBs in AF prevention
The Role of ACEI and ARBs in AF prevention Dr. Sameh Shaheen MD, FESC Prof. of cardiology Ain-Shams university Time course of atrial substrate remodeling in relation to the clinical appearance of AF and
More informationALLHAT Role of Diuretics in the Prevention of Heart Failure - The Antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial
1 ALLHAT Role of Diuretics in the Prevention of Heart Failure - The Antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial Davis BR, Piller LB, Cutler JA, et al. Circulation 2006.113:2201-2210.
More informationTHE FRAMINGHAM STUDY Protocol for data set vr_soe_2009_m_0522 CRITERIA FOR EVENTS. 1. Cardiovascular Disease
THE FRAMINGHAM STUDY Protocol for data set vr_soe_2009_m_0522 CRITERIA FOR EVENTS 1. Cardiovascular Disease Cardiovascular disease is considered to have developed if there was a definite manifestation
More informationEfficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis
Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis Dipak Kotecha, MD PhD on behalf of the Selection of slides presented at the European
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 informationHeart Failure Dr ahmed almutairi Assistant professor internal medicin dept
Heart Failure Dr ahmed almutairi Assistant professor internal medicin dept (MBBS)(SBMD) Introduction Epidemiology Pathophysiology diastolic/systolic Risk factors Signs and symptoms Classification of HF
More informationOnline Appendix (JACC )
Beta blockers in Heart Failure Collaborative Group Online Appendix (JACC013117-0413) Heart rate, heart rhythm and prognostic effect of beta-blockers in heart failure: individual-patient data meta-analysis
More informationClinical Updates in the Treatment of Hypertension JNC 7 vs. JNC 8. Lauren Thomas, PharmD PGY1 Pharmacy Practice Resident South Pointe Hospital
Clinical Updates in the Treatment of Hypertension JNC 7 vs. JNC 8 Lauren Thomas, PharmD PGY1 Pharmacy Practice Resident South Pointe Hospital Objectives Review the Eighth Joint National Committee (JNC
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 informationA study of Brain Natriuretic Peptide levels in acute cardiac failure
Original Research Article A study of Brain Natriuretic Peptide levels in acute cardiac failure Bhavik Prajapati 1*, Anirudh Kulkarni 2 1 Assistant Professor, Department of Medicine, SMS Multispecialty
More informationHypertension in the very old. Objectives: Clinical Perspective
Harvard Medical School Hypertension in the very old Ihab Hajjar, MD, MS, AGSF Associate Director, CV Research Lab Assistant Professor of Medicine, Harvard Medical School Objectives: Describe the clinical
More informationProtocol Identifier Subject Identifier Visit Description. [Y] Yes [N] No. [Y] Yes [N] N. If Yes, admission date and time: Day Month Year
PAST MEDICAL HISTORY Has the subject had a prior episode of heart failure? o Does the subject have a prior history of exposure to cardiotoxins, such as anthracyclines? URGENT HEART FAILURE VISIT Did heart
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 informationDefinition of Congestive Heart Failure
Heart Failure Definition of Congestive Heart Failure A clinical syndrome of signs & symptoms resulting from the heart s inability to supply adequate tissue perfusion. CHF Epidemiology Affects 4.7 million
More informationHFpEF. April 26, 2018
HFpEF April 26, 2018 (J Am Coll Cardiol 2017;70:2476 86) HFpEF 50% or more (40-71%) of patients with CHF have preserved LV systolic function. HFpEF is an increasingly frequent hospital discharge. Outcomes
More informationIdentification of patients with heart failure and PREserved systolic Function : an Epidemiologic Regional study
Identification of patients with heart failure and PREserved systolic Function : an Epidemiologic Regional study Dr. Antonio Magaña M.D. (on behalf I-PREFER investigators group) Stockholm, Sweden, August
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 informationHeart Failure in Women
Heart Failure in Women Disclosure Professor Sindone has received honoraria, speaker fees, consultancy fees, is a member of advisory boards or has appeared on expert panels for: Professor Andrew Sindone
More informationPrevention of Atrial Fibrillation by Renin-Angiotensin System Inhibition
Journal of the American College of Cardiology Vol. 55, No. 21, 2010 2010 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2010.01.043
More informationRegression of Electrocardiographic Left Ventricular Hypertrophy by Losartan Versus Atenolol
Regression of Electrocardiographic Left Ventricular Hypertrophy by Losartan Versus Atenolol The Losartan Intervention For Endpoint reduction in hypertension (LIFE) Study Peter M. Okin, MD; Richard B. Devereux,
More informationTHE PROPER APPROACH TO DIAGNOSING HEART FAILURE WITH PRESERVED EJECTION FRACTION
THE PROPER APPROACH TO DIAGNOSING HEART FAILURE WITH PRESERVED EJECTION FRACTION James C. Fang, MD, FACC Professor and Chief Cardiovascular Division University of Utah School of Medicine Disclosures Data
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 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 informationSUPPLEMENTAL MATERIAL
SUPPLEMENTAL MATERIAL Table S1: Number and percentage of patients by age category Distribution of age Age
More informationJared Moore, MD, FACP
Hypertension 101 Jared Moore, MD, FACP Assistant Program Director, Internal Medicine Residency Clinical Assistant Professor of Internal Medicine Division of General Medicine The Ohio State University Wexner
More informationObservational, population-based studies demonstrate that
Systolic Blood Pressure Control and Mortality After Stroke in Hypertensive Patients Peter M. Okin, MD; Sverre E. Kjeldsen, MD; Richard B. Devereux, MD Background and Purpose Hypertensive patients with
More informationHeart Failure. Dr. William Vosik. January, 2012
Heart Failure Dr. William Vosik January, 2012 Questions for clinicians to ask Is this heart failure? What is the underlying cause? What are the associated disease processes? Which evidence-based treatment
More informationPharmacological Treatment for Chronic Heart Failure. Dr Elaine Chau HK Sanatorium & Hospital, Hong Kong 3 August 2014
Pharmacological Treatment for Chronic Heart Failure Dr Elaine Chau HK Sanatorium & Hospital, Hong Kong 3 August 2014 1 ACC/AHA 2005 guideline update for Diagnosis & management of CHF in the Adult -SA Hunt
More informationHypertension. Does it Matter What Medications We Use? Nishant K. Sekaran, M.D. M.Sc. Intermountain Heart Institute
Hypertension Does it Matter What Medications We Use? Nishant K. Sekaran, M.D. M.Sc. Intermountain Heart Institute Hypertension 2017 Classification BP Category Systolic Diastolic Normal 120 and 80 Elevated
More informationHypertension and Atrial Fibrillation in 2017
Boma Inn, Eldoret, 24th 25thFebruary 2017 Hypertension and Atrial Fibrillation in 2017 Dr Mzee Ngunga Consultant Cardiologist Aga Khan University Hospital, Nairobi Objectives 1. Understand the relationship
More informationAtrial fibrillation: a key determinant in the cardiovascular risk continuum. u Prof. Joseph S. Alpert u Arizona, USA
Atrial fibrillation: a key determinant in the cardiovascular risk continuum u Prof. Joseph S. Alpert u Arizona, USA Disclosures u No major conflicts of interest: all honoraria
More informationThe Hearth Rate modulators. How to optimise treatment
The Hearth Rate modulators How to optimise treatment Munich, ESC Congress 2012 Prof. Luigi Tavazzi GVM Care&Research E.S. Health Science Foundation Cotignola, IT Disclosure Cooperation with: Servier, Medtronic,
More informationAntihypertensive Trial Design ALLHAT
1 U.S. Department of Health and Human Services Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic National Institutes
More informationAll in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, MFMER
ICD for NICM All in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, 2017 2017 MFMER 3686275-1 DISCLOSURE Relevant Financial Relationship(s)
More information1. Albuminuria an early sign of glomerular damage and renal disease. albuminuria
1. Albuminuria an early sign of glomerular damage and renal disease albuminuria Cardio-renal continuum REGRESS Target organ damage Asymptomatic CKD New risk factors Atherosclerosis Target organ damage
More informationSBP in range of 120 to 140 :no progression or regression of CAD. Sipahi et al., 2006
Management of Hypertension in Patients with CAD M. Mohsen Ibrahim, MD Cardiology Department- Cairo University 1. What is the optimal BP in patients with hypertension and CAD? 2. What is the minimum safe
More informationCardiovascular Diseases in CKD
1 Cardiovascular Diseases in CKD Hung-Chun Chen, MD, PhD. Kaohsiung Medical University Taiwan Society of Nephrology 1 2 High Prevalence of CVD in CKD & ESRD Foley RN et al, AJKD 1998; 32(suppl 3):S112-9
More informationARNI (Angiotensin Receptor blocker / Neprilysin Inhibitors [Sacubutril/Valsartan]) Heart Failure Medication Initiation and Titration
ARNI (Angiotensin Receptor blocker / Neprilysin Inhibitors [Sacubutril/Valsartan]) Heart Failure Medication and Symptomatic HF despite ACEI/ARB and B-blocker therapy Bilateral renal artery stenosis Moderate/Severe
More informationΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ. Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH
ΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH Hypertension Co-Morbidities HTN Commonly Clusters with Other Risk
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 informationRationale for the use of Single Pill Combination (SPC) and Asian data of ARB/CCB SPC
Rationale for the use of Single Pill Combination (SPC) and Asian data of ARB/CCB SPC Seung Woo Park, MD Samsung Medical Center BP Control Rates in Asia BP controlled BP uncontrolled 24.3% 36.6% 19% Turkey
More informationARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM
ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM ID NUMBER: FORM NAME: H F A DATE: 10/01/2015 VERSION: D CONTACT YEAR NUMBER: FORM SEQUENCE NUMBER: General Instructions: The Heart Failure Hospital Record
More informationSGK 2016 Session: Postgraduate Course in Heart Failure Lausanne, 15. June 2016 Heart Failure Guidelines 2016
SGK 2016 Session: Postgraduate Course in Heart Failure Lausanne, 15. June 2016 Heart Failure Guidelines 2016 Matthias Nägele, MD University Hospital Zurich Disclosures I have nothing to disclose. The new
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 Stage B Heart Failure
KSC 2017 Management of Stage B Heart Failure Byung Su Yoo, MD., PhD. Division of Cardiology, Wonju College of Medicine, Yonsei University, South Korea Focused on Symptom ASLVSD, ASLVDD LVH HF progression
More informationThe Failing Heart in Primary Care
The Failing Heart in Primary Care Hamid Ikram How fares the Heart Failure Epidemic? 4357 patients, 57% women, mean age 74 years HFSA 2010 Practice Guideline (3.1) Heart Failure Prevention A careful and
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 informationDisclosure Information : No conflict of interest
Intravenous nicorandil improves symptoms and left ventricular diastolic function immediately in patients with acute heart failure : a randomized, controlled trial M. Shigekiyo, K. Harada, A. Okada, N.
More informationDr Dinna Soon. Consultant Cardiologist, Department of Cardiology. GP symposium 2 April 2016
Dr Dinna Soon Consultant Cardiologist, Department of Cardiology GP symposium 2 April 2016 Case presentation 76 years old male, chronic smoker, hypertension, previous MI 3/7 SOB and chest tightness BP
More informationORIGINAL INVESTIGATION. Profile for Estimating Risk of Heart Failure
ORIGINAL INVESTIGATION Profile for Estimating Risk of Heart Failure William B. Kannel, MD, MPH; Ralph B. D Agostino, PhD; Halit Silbershatz, PhD; Albert J. Belanger, MS; Peter W. F. Wilson, MD; Daniel
More informationBlood Pressure Targets in Diabetes
Stockholm, 29 th August 2010 ESC Meeting Blood Pressure Targets in Diabetes Peter M Nilsson, MD, PhD Department of Clinical Sciences University Hospital, Malmö Sweden Studies on BP in DM2 ADVANCE RCT (Lancet
More informationHeFSSA Practitioners Program 2017 Theme The Patient Journey: Feel Good and Live Long. Case Study 2
HeFSSA Practitioners Program 2017 Theme The Patient Journey: Feel Good and Live Long Case Study 2 HEART FAILURE WITH MID-RANGE EJECTION FRACTION TREATMENT OPTIONS CLINICAL CASE MEDICAL HISTORY 59-year-old
More informationDisclosures. Overview. Goal statement. Advances in Chronic Heart Failure Management 5/22/17
Disclosures Advances in Chronic Heart Failure Management I have nothing to disclose Van N Selby, MD UCSF Advanced Heart Failure Program May 22, 2017 Goal statement To review recently-approved therapies
More informationA patient with decompensated HF
A patient with decompensated HF Professor Michel KOMAJDA University Pierre & Marie Curie Pitie Salpetriere Hospital Department of Cardiology Paris (France) Declaration Of Interest 2010 Speaker : Servier,
More informationAldosterone Antagonism in Heart Failure: Now for all Patients?
Aldosterone Antagonism in Heart Failure: Now for all Patients? Inder Anand, MD, FRCP, D Phil (Oxon.) Professor of Medicine, University of Minnesota, Director Heart Failure Program, VA Medical Center 111C
More informationDisclosures. Advances in Chronic Heart Failure Management 6/12/2017. Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017
Advances in Chronic Heart Failure Management Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017 I have nothing to disclose Disclosures 1 Goal statement To review recently-approved therapies
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 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 informationControversies with regard to 'upstream therapy of atrial fibrillation
Controversies with regard to 'upstream therapy of atrial fibrillation Barbara Casadei Department of Cardiovascular Medicine John Radcliffe Hospital University of Oxford No conflict of interest to declare
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 informationProf. Samir Morcos Rafla Alexandria Univ. Cardiology Dept.
Obesity as a risk factor for Atrial Fibrillation Prof. Samir Morcos Rafla Alexandria Univ. Cardiology Dept. CardioAlex 2010 smrafla@hotmail.com 1 Obesity has reached epidemic proportions in the United
More information12 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices. Heart Rate as a Cardiovascular Biomarker
12 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices Heart Rate as a Cardiovascular Biomarker Inder Anand, MD, FRCP, D Phil (Oxon.) Professor of Medicine,
More informationHeart Failure and Atrial Fibrillation
Heart Failure and Atrial Fibrillation 신미승 가천의대심장내과 Prevalence of AF & CHF AF : the most common cardiac arrhythmia more than 2.2 million Americans -- 2007 ACC CHF : more than 5 million Americans The prevalence
More informationARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM. General Instructions: ID NUMBER: FORM NAME: H F A DATE: 10/13/2017 VERSION: CONTACT YEAR NUMBER:
ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM General Instructions: The Heart Failure Hospital Record Abstraction Form is completed for all heart failure-eligible cohort hospitalizations. Refer to
More informationCongestive Heart Failure or Heart Failure
Congestive Heart Failure or Heart Failure Dr Hitesh Patel Ascot Cardiology Group Heart Failure Workshop April, 2014 Question One What is the difference between congestive heart failure and heart failure?
More informationIncidence. 4.8 million in the United States. 400,000 new cases/year. 20 million patients with asymptomatic LV dysfunction
Heart Failure Diagnosis According to the Working Group in Heart Failure, CHF is a syndrome where the diagnosis has the following essential components: A combination of: Symptoms, typically breathlessness
More informationCombination Therapy for Hypertension
Combination Therapy for Hypertension Se-Joong Rim, MD Cardiology Division, Yonsei University College of Medicine, Seoul, Korea Goals of Therapy Reduce CVD and renal morbidity and mortality. Treat to BP
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 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 informationAF in the ER: Common Scenarios CASE 1. Fast facts. Diagnosis. Management
AF in the ER: Common Scenarios Atrial fibrillation is a common problem with a wide spectrum of presentations. Below are five common emergency room scenarios and the management strategies for each. Evan
More informationHeart Failure. Cardiac Anatomy. Functions of the Heart. Cardiac Cycle/Hemodynamics. Determinants of Cardiac Output. Cardiac Output
Cardiac Anatomy Heart Failure Professor Qing ZHANG Department of Cardiology, West China Hospital www.blaufuss.org Cardiac Cycle/Hemodynamics Functions of the Heart Essential functions of the heart to cover
More information10. Definition of cardiovascular disease 10.1 Nosologic definitions Acute myocardial infarction: myocardial cell death due to prolonged ischaemia 62.
10. Definition of cardiovascular disease 10.1 Nosologic definitions Acute myocardial infarction: myocardial cell death due to prolonged ischaemia 62. Acute coronary syndrome: it is a big category which
More informationHeart Failure Clinician Guide JANUARY 2016
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Heart Failure Clinician Guide JANUARY 2016 Introduction This evidence-based guideline summary is based on the 2016 National Heart Failure Guideline.
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 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 informationNCAP NATIONAL CARDIAC AUDIT PROGR AMME NATIONAL HEART FAILURE AUDIT 2016/17 SUMMARY REPORT
NCAP NATIONAL CARDIAC AUDIT PROGR AMME NATIONAL HEART FAILURE AUDIT 2016/17 SUMMARY REPORT CONTENTS PATIENTS ADMITTED WITH HEART FAILURE...4 Demographics... 4 Trends in Symptoms... 4 Causes and Comorbidities
More informationForm 136 WHI WOMEN S HEALTH INITIATIVE HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM
Form 136 WHI WOMEN S HEALTH INITIATIVE HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM FORM NAME: H T F DATE: 10/31/2012 VERSION: A MEMBER ID NUMBER: General Instructions: This form should be completed
More informationPolypharmacy - arrhythmic risks in patients with heart failure
Influencing sudden cardiac death by pharmacotherapy Polypharmacy - arrhythmic risks in patients with heart failure Professor Dan Atar Head, Dept. of Cardiology Oslo University Hospital Ullevål Norway 27.8.2012
More informationHeart Failure in Women: Dr Goh Ping Ping Cardiologist Asian Heart & Vascular Centre
Heart Failure in Women: More than EF? Dr Goh Ping Ping Cardiologist Asian Heart & Vascular Centre Overview Review pathophysiology as it relates to diagnosis and management Rational approach to workup:
More informationScreening for heart failure in individuals with diabetes: a cross-sectional study
Mædica - a Journal of Clinical Medicine ORIGIN RIGINAL PAPERS APERS: CLINICAL OR BASIC RESEARCH Screening for heart failure in individuals with diabetes: a cross-sectional study Cornelia BALA, MD a,b ;
More informationSleep Apnea and Heart Failure
Sleep Apnea and Heart Failure Micha T. Maeder, MD Cardiology Division Kantonsspital St. Gallen Switzerland micha.maeder@kssg.ch Sleep Disordered Breathing (SDB) in HFrEF 700 HFrEF patients (LVEF
More informationCauses of death in Diabetes
Rates of CV events in Diabetes patients Respiratory4.2 Cancer 7.6 Diabetes 1.3 CV disease 17.3 Causes of death in Diabetes 250 200 150 100 50 0 per 10,000 person-years 97 151 243 Framingham 5 X increase
More informationJournal of Hypertension 2006, 24: a Centro Interuniversitario di Fisiologia Clinica e Ipertensione, University of Milan,
Original article 2163 Outcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: an analysis of findings from the VALUE trial Alberto Zanchetti a, Stevo Julius
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 informationTodd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM
Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM Faculty Disclosure I have no financial interest to disclose No off-label use of medications will be discussed FIFTH ANNUAL SYMPOSIUM Recognize changes between
More informationDifficult to Treat Hypertension
Difficult to Treat Hypertension According to Goldilocks JNC 8 Blood Pressure Goals (2014) BP Goal 60 years old and greater*- systolic < 150 and diastolic < 90. (Grade A)** BP Goal 18-59 years old* diastolic
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 informationWhat s In the New Hypertension Guidelines?
American College of Physicians Ohio/Air Force Chapters 2018 Scientific Meeting Columbus, OH October 5, 2018 What s In the New Hypertension Guidelines? Max C. Reif, MD, FACP Objectives: At the end of the
More informationHypertension Guidelines: Are We Pressured to Change? Oregon Cardiovascular Symposium Portland, Oregon June 6, Financial Disclosures
Hypertension Guidelines: Are We Pressured to Change? Oregon Cardiovascular Symposium Portland, Oregon June 6, 2015 William C. Cushman, MD Professor, Preventive Medicine, Medicine, and Physiology University
More informationDEPARTMENT OF GENERAL MEDICINE WELCOMES
DEPARTMENT OF GENERAL MEDICINE WELCOMES 1 Dr.Mohamed Omar Shariff, 2 nd Year Post Graduate, Department of General Medicine. DR.B.R.Ambedkar Medical College & Hospital. 2 INTRODUCTION Leading cause of global
More informationThe earlier BP control the better cardiovascular outcome. Jin Oh Na Cardiovascular center Korea University Medical College
The earlier BP control the better cardiovascular outcome Jin Oh Na Cardiovascular center Korea University Medical College Index Introduction HOPE-3 Trial Sprint Study Summary Each 2 mmhg decrease in SBP
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 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 informationDECLARATION OF CONFLICT OF INTEREST. None
DECLARATION OF CONFLICT OF INTEREST None How low should we go to avoid harm in hypertensives with comorbidities? CORONARY ARTERY DISEASE Prof. Dr. Maria DOROBANTU, FESC,FACC CARDIOLOGY EMERGENCY HOSPITAL
More informationLITERATURE REVIEW: HEART FAILURE. Chief Residents
LITERATURE REVIEW: HEART FAILURE Chief Residents Heart Failure EF 40% HFrEF Problem with contractility EF 40-50% HFmrEF EF > 50% HFpEF Problem with filling/relaxation RISK FACTORS Post MI HTN DM Obesity
More informationApproach to patient with hypertension. Dr. Amitesh Aggarwal
Approach to patient with hypertension Dr. Amitesh Aggarwal Definition A systolic blood pressure ( SBP) >139 mmhg and/or A diastolic (DBP) >89 mmhg. Based on the average of two or more properly measured,
More informationHFpEF: Pathophysiology & Treatment
HFpEF: Pathophysiology & Treatment Barry A. Borlaug, MD Mayo Clinic, Rochester, MN borlaug.barry@mayo.edu Disclosure Financial Relationships Research Support: Aires Pharmaceuticals, Medtronic, GSK Consulting/Advisory
More informationTrials Enrolled subjects Findings Fox et al. 2014, SIGNIFY 1
Appendix 5 (as supplied by the authors): Published trials on the effect of ivabradine on outcomes including mortality in patients with different cardiovascular diseases Trials Enrolled subjects Findings
More information