Η θέση της αντισπερτασικής αγωγής στην πρόληψη της κολπικής μαρμαρσγής. Ανδρέας Πιηηαράς. Σεμινάριο ΟΕ ΕΚΕ Θεζζαλονίκη 2012
|
|
- Reginald Stokes
- 5 years ago
- Views:
Transcription
1 Η θέση της αντισπερτασικής αγωγής στην πρόληψη της κολπικής μαρμαρσγής Ανδρέας Πιηηαράς Σεμινάριο ΟΕ ΕΚΕ Θεζζαλονίκη 2012
2 AF May Present with a Wide Range of Symptoms LIGHT- HEADEDNESS PALPITATIONS SYNCOPE DYSPNEA FATIGUE CHEST PAIN ACC/AHA/ESC 2006 guidelines Eur Heart J 2006;27(16):
3 EHRA score of AF-related symptoms EHRA class EHRA I EHRA II EHRA III EHRA IV No symptoms Explanation Mild symptoms ; normal activity not affected Severe symptoms normal daily activity affected Disabling symptoms ; normal daily activity discontinued EHRA = European Heart Rhythm Association
4 ACC/AHA/ESC 2006 guidelines Eur Heart J 2006;27(16):
5
6 Presence of AF in Different Stages of CV Continuum Myocardial Infarction Neurohormonal activation CAD Subclinical Organ Damage AF Remodeling Ventricular dilation Risk factors Hypertension Diabetes Smoking Obesity LV H & Atrial Dilation Heart Failure
7 AF costs USA $26 billion ( 17.5 billion) each year Circulation Cardiovasc. Qual. Outcomes June 2011
8 Age-adjusted odds ratio Risk Factor for the Development of AF 38-year follow-up of the Framingham study Cigarettes Diabetes ECG LVH HTN BMI Alcohol Risk factors
9 Influence of SBP and DBP on the Risk of Incident AF in Women SBP mmhg DBP mmhg Conen D et al. Circulation 2009;119:2146
10 5 year age adjusted risk of chronic atrial fibrillation (%) AF in Hypertension Age-adjusted 5-year risk of chronic AF in hypertensive subjects in sinus rhythm Reported values are the three division points for quartiles Left atrial diameter (cm) LV mass (g/h 2.7 ) Hypertension 2003;41:218 23
11 Pulse Pressure and Risk of New-Onset AF Incidence of AF according to quartiles of PP 23.3% 5.6% 20 mm Hg increase in pulse pressure was associated with a 34% increase in the risk for developing AF Mitchell et al, JAMA 2007; 297: 709
12 Patients with hypertension, % Prevalence of Hypertension in AF Trials 90 AF populations
13 Over Time AF Causes Atrial Remodelling Electrical remodelling Shortening of atrial refractory periods Occurs rapidly (within several days) and contributes to the increased stability of AF Contractile remodelling Reduced atrial contractility Sets the stage for thrombus formation May lead to atrial dilation further altering electrophysiologic properties Occurs rapidly -80 mv Shortened refractory period Structural remodelling Histologic changes Left atrium and left atrial appendage enlargement Decrease in cardiac output Occurs after a period of weeks to months Van Gelder et al. Europace 2006;8:
14 Mechanisms of initiation AF Catecholamine excess, Ηemodynamic stress, Αtrial ischemia, Atrial inflammation, Μetabolic stress, and Νeurohumoral cascade activation are all purported to promote AF. AF appears to require both an initiating event and a permissive atrial substrate.
15 Risk Factors, Clinical Conditions and Markers for the Development of AF Risk factors Age Hypertension Diabetes mellitus Obesity Metabolic syndrome Alcohol consumption Smoking Clinical conditions Left ventricular hypertrophy Myocardial infarction Heart failure Obstructive sleep apnoea Renal dysfunction Valvular heart disease Thyroid disease Markers Increased arterial stiffness Left atrial enlargement Increased PR interval P wave dispression Birth weight hs-crp Inflammatory markers Neurohormones Genetic variants Pulse pressure
16 Male, 55 yrs, hypertensive, hyperlipidemia, obese, LVH, ETT(+), Th201(+), CA(-), NE:480 pg/ml, E:0.2 pg/ml, AVP:2.2 pg/ml, PRA:2.4ng/ml
17 2007 ESH/ESC Guidelines Preferred Drugs Condition Subclinical OD Clinical Event ISH (elderly) D / CA MS (or risk of incident DM) ACEI / ARB (+CA / low dose D) DM ACEI / ARB Pregnancy CA / MD / BB Blacks D / CA LVH Asympt. atherosclerosis MA Renal dysfunction Previous stroke Previous MI Angina pectoris CHF AF (recurrent) AF (permanent) ESRF/proteinuria PAD ACEI / CA / ARB CA / ACEI ACEI / ARB ACEI / ARB any BP lowering agent BB / ACEI / ARB BB / CA D / BB / ACEI / ARB / antialdo agents ARB / ACEI BB / nondhca ACEI / ARB / loop D CA
18 The Role of RAAS in the pathogenesis of AF Angiotensinogen Angiotensin I Renin ACE ACE I Angiotensin II ARB Cardiac fibrosis Electrical remodeling Cardiac Hypertrophy Hypertension Atrial Pressure and stretch Sympathetic overactivity Pro-inflammatory effects
19 How Did RAS Blockers Reduce the Risk of Stroke Beyond Blood Pressure? Cardiac remodeling/ enlargement Vascular remodeling Reduced ECG LVH Inhibited atherosclerosis formation Reduced carotid artery hypertrophy Reduced gluteal artery hypertrophy Endothelial dysfunction Improved endothelial function Prothrombotic state Inhibition of platelet aggregation Reduced proaggregatory factors
20 LV mass Reduction (%) Meta-analysis of randomized, controlled trials of LV hypertrophy regression in essential hypertension 0 Diuretics -blockers Caantagonist ACEinhibitors ARBs % -6% -11% -10% % randomized controlled trials; 4,113 patients Schmieder RE et al. Am J Med 2003; 115:41-6.
21 Angiotensin II in the Pathogenesis of AF Spironolactone Aldosterone? Bradykinin ACE Atrial stretch ACEI ARB MARK AT II Ca² overload ARB Fibroblast proliferation Collagen accumulation Hypertrophy Apoptosis Conduction block AERP shortening Electrical remodelling Delayed depolarisations Enhanced automaticity Atrial dilatation AF
22 Atrial fibrillation reduces myocardial perfusion reserve Myocardial perfusion Coronary resistance 5 Controls AF 200 Controls AF 4 p< p= p=0.029 p< Baseline Adenosin Baseline Adenosin
23 Repair of Coronary Arterioles After Treatment with Perindopril in Hypertensive Heart Disease % Morphological and Haemodynamic changes before and after treatment. 70 # 54% # 67% 0 LVMI * 12% CBF CVR CR PCA TIC # 33% * 22% -70 PCA: Periarteriolar collagen area TIC: Total Interstitial Collagen * 54% * p < 0,04 # p < Hypertension 2000
24 Percent Seconds ARB reduces AF by suppression the process of the structural remodelling Persistent atrial fibrillation in 20 dogs, fibrosis induced by rapid pacing of the right atrium over 5 weeks Interstitial fibrosis Duration of AF *** *** 0 0 ** p<0.01 vs controls ***p<0.001 vs controls Controls Candesartan
25 P-wave dispersion (PWD) has been shown to be a noninvasive electrocardiographic predictor for development of atrial fibrillation (AF). Thus, it may be possible to attenuate AF risk through improvement of PWD. In this study, we compared the effects of quinapril, and irbesartan, on PWD. Antihypertensive treatment with either irbesartan or quinapril is associated with significant reductions in Pmax and PWD. Guntekin Pacing & Electrophysiology Journal31 July 2009
26 Blood pressure control and risk of incident AFib Background AF is a common arrhythmia that affects over 2 million people in the US. We sought to determine whether the risk of incident AF among patients treated for HTN differs by the degree of BP control. Methods A population based, case-control study of 433 patients with verified incident AF and 899 controls was conducted to investigate the relationship between average achieved SBP and DBP and risk of AF. All patients were members of an integrated health care delivery system and were pharmacologically treated for HTN. Medical records were reviewed to confirm the diagnosis of new onset AF and to collect information on medical conditions, health behaviors, and measured blood pressures. Average achieved SBP and DBP were calculated from the three most recent outpatient blood pressure measurements.
27 Blood pressure control and risk of incident atrial fibrillation Results Compared with the reference level of mm Hg, for categories of average achieved SBP of <120, , , , and 170 mm Hg, the odds ratios (95% confidence interval) for incident AF were 1.99 (1.10, 3.62), 1.19 (0.78, 1.81), 1.40 (0.93, 2.09), 2.02 (1.30, 3.15), 2.27 (1.31, 3.93) and 1.84 (0.89, 3.80), respectively. Based on the population attributable fraction (PAF), we estimated that, among patients with treated hypertension, 17.2% (95% CI 4.3%, 28.3%) of incident AF was attributable to an average achieved SBP 140 mmhg. Conclusion Among patients treated for hypertension, uncontrolled elevated SBP and SBP <120 mm Hg were associated with an increased risk of incident AF. Am J Hypertens April 1.
28 Atrial Fibrillation (AF) - Primary Prevention In 2007 ESH / ESC guidelines recommendation to preferentially use ARBs / ACEIs Evidence mainly from post-hoc analyses Also plausible pathophysiological explanation, i.e. effectiveness of RAS blocker on LVH regression and relationship of LVH regression with AF No consistent support from recent trials - TRANSCEND - PROFESS - I-Preserve
29 Atrial Fibrillation In a meta-analysis on almost patients with systolic HF BBs were found to reduce (-27%) AF In patients with an AF history and systolic HF BBs are a specific indication
30 Protection against Recurrent AF In 2007 ESH/ESC guidelines preferential use of ARBs / ACEIs recommended, with stress on small number of patients / need for new studies No support from two new studies - CAPRAF - GISSI-AF (85% HTs) Support from recent meta-analysis by Schmieder et al (?)
31 Proportion of patients with first event (%) LIFE Study Primary Composite Endpoint 16 Intention-to-treat 14 Adjusted risk reduction 13 0%, P=0 021 Unadjusted risk reduction 14 6%, P= Atenolol 8 6 Losartan 4 2 Study Month Losartan (n) Atenolol (n) Dahlof B, et al. Lancet. 2002; 359:
32 Proportion of patients with first event (%) LIFE Study: Fatal and Non-Fatal Stroke Intention-to-treat Adjusted risk reduction 24 9%, P=0 001 Unadjusted risk reduction 25 8%, P= Atenolol Losartan Study Month
33 Proportion of patients with first event (%) Losartan Significantly Reduced the Risk of New-Onset AF by 33% HR: 0.67 [95% CI: ], p<0.001 Adj HR: 0.67 [95% CI: ], p<0.001 Losartan group Atenolol group Time (months) HR = hazard ratio; CI = confidence interval Adapted from Wachtell et al J Am Coll Cardiol 2005;45:
34 Percent LIFE Study: Patients with new onset AF had an increased risk of cardiovascular events % 10.7% 15.4% Patients with new onset AF (n=371) Patients with sinus rhythm (n=8480) % 4.2% 5% 6.7% 4% 0 (n=82) (n=911) (n=28) (n=352) (n=57) (n=428) (n=25) (n=342) Composite end-point Cardiovascular mortality Fatal or non Fatal stroke MI
35 Proportion of patients with first event (%) Reduction in Risk of Stroke in Patients with AF Fatal and nonfatal stroke Atenolol 15 Losartan Adjusted risk reduction 49%, p = Time (months)
36 CONCLUSIONS: In this high-risk hypertensive population, pre-existing and new-onset AF/AFL were associated with increased mortality. Excluding doxazosin, treatment assignment to either antihypertensive drugs or pravastatin versus usual care did not affect AF/AFL incidence. J Am Coll Cardiol Nov 24;54(22): (ALLHAT GROUP)
37 Occurrence of Atrial Fibrillation According to Antihypertension Treatment: IR per 1,000 Person-Years of Atrial Fibrillation Related Hospitalization, Adjusted Incidence Ratio, and 95% CI Matched Cohorts ACEI IR CCB IR ACEI Versus CCB Ration (95% CI)* Three years ( ) Five years ( ) Entire follow up ( ) *Poisson regression L Allier PL et al. J Am Coll Cardiol 2004
38 ACE-Inhibition in HTN Patients is Associated with a Reduction in the Occurrence of AF Kaplan-Meir curves for the time to first occurrence of AF L Allier PL et al. J Am Coll Cardiol 2004
39 Prevention of recurrence in patients with lone AF. The dose dependent effect of ARB s Madrid a. et al JRAAS 2004
40 Prospective randomised study comparing amiodarone vs amiodarone plus losartan vs amiodarone plus perindopril for the prevention of AF recurrence in pts with lone paroxysmal AF AF recurence-free Survival LA Diameter A+L A+P A A A+L A+P Yin Y et al. Eur Heart J 2006
41 Kaplan-Meier Curves for the Primary Outcome Massie B et al. N Engl J Med 2008; /NEJMoa
42 Valsartan for Prevention of Recurrent AF The GISSI-AF Investigators N Engl J Med 2009;360:1606
43 Prevention of Recurrent Lone AF by ACE-I Ramipril in Normotensive Patients Belluzzi F et al. J Am Coll Cardiol 2009;53:24
44 Atrial Fibrillation: ANTIPAF study OBJECTIVE: The Angiotensin II-Antagonist in Paroxysmal Atrial Fibrillation Trial (ANTIPAF Trial) is testing whether the ARB, OLMESARTAN (40 mg/day) reduces the incidence of episodes of AF in patients with paroxysmal AF during 12 months by more than 25% compared to standard medication Number Of Patients: 422 Patients
45
46
47 Meta-analysis: Inhibition of RAAS prevents new-onset AF 95% CI RR Lower Limit Upper Limit % Weight Hypertension trials CAPPP STOP LIFE VALUE Pooled RR Post-myocardial infarction trials GISSI TRACE Pooled RR Heart failure trials Val-HeFT SOLVD CHARM Pooled RR Kishlay A. et al., Am. Hear J 2006; 152:
48 Risk for Incidence AF in Patients who Receive Antihypertensive Drugs UK-based General Practice Research Database hypertensive pts 4661 pts with new AF Hypertensive pts receiving long-term monotherapy with ACE-I, ARB s, or β-blockers were less likely to develop AF than those whose received only CCB s CCB s vs ACE-I OR 0.75 vs ARB s OR 0.71 vs β-blockers OR 0.78 Schaer B et al. Ann Intern Med 2010;152:78
49 Prevention of AF by RAS Inhibition A Meta-Analysis 23 randomized controlled trials 87,048 patients In primary prevention 6 trials in HTN 2 trials in MI 3 trials in HF In In secondary prevention 8 trials after cardioversion and 4 trials on medical prevention of recurrence Schneider M. J. Am. Coll. Cardiol : A27
50 Prevention of AF by RAS Inhibition A Meta-Analysis RAS inhibition reduced the odds ratio for AF by 33% (p < ) In primary prevention, RAS inhibition in pts with heart failure (+) HTN and LVH (+) Post-MI patients overall (-). In secondary prevention, RAS inhibition was often administered on top of antiarrhythmics (amiodarone), further reducing the odds for AF recurrence after cardioversion by 45% (p = 0.01) and in patients on medical therapy by 63% (p < ) Schneider M. J. Am. Coll. Cardiol : A27
51 Prevention of AF by RAS Inhibition A Meta-Analysis Conclusions: This analysis supports the concept of RAS inhibition as an emerging treatment for the primary and secondary prevention of AF but acknowledges the fact that some of the primary prevention trials were post-hoc analyses. Further areas of uncertainty include potential differences among specific RAS inhibitors and possible interactions or synergistic effects with antiarrhythmic drugs. Schneider M. J. Am. Coll. Cardiol : A27
52
53
54
55
56 Primary outcome (%) The SENIORS trial subgroup analysis: atrial fibrillation Placebo % 36.7% 33.8% 29.1% Nebivolol Atrial fibrillation Non-atrial fibrillation
57 Agents with antialdosterone properties should be the preferred diuretics for reducing hypertension related atrial fibrillation. Jolobe OM. Eur J Intern Med Feb;21(1):55. Epub 2009 May 17.
58
59
60 Hypertension and atrial fibrillation: diagnostic approach, prevention and treatment. Position paper of the Working Group 'Hypertension Arrhythmias and Thrombosis' of the European Society of Hypertension A. Manolis et al. J Hypertens Feb;30(2):
61
Prevention of Atrial Fibrillation and Heart Failure in the Hypertensive Patient
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
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 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 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 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 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 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 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 informationIndividual management of arterial hypertension. Doumas Michael, Internist Lecturer, Aristotle University, Thessaloniki
Individual management of arterial hypertension Doumas Michael, Internist Lecturer, Aristotle University, Thessaloniki From Population to Individual Management of Arterial Hypertension Epidemiologic impact
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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 informationΗ σημασία της αρτηριακής σκληρίας στην εκτίμηση της διαστολικής δυσλειτουργίας στην υπέρταση. Θεραπευτικές παρεμβάσεις
Η σημασία της αρτηριακής σκληρίας στην εκτίμηση της διαστολικής δυσλειτουργίας στην υπέρταση. Θεραπευτικές παρεμβάσεις Ελένη Τριανταφυλλίδη Επιμελήτρια Α Β Πανεπιστημιακή Καρδιολογική Κλινική Αττικό Νοσοκομείο
More informationAtrial Fibrillation and Heart Failure: A Cause or a Consequence
Atrial Fibrillation and Heart Failure: A Cause or a Consequence Rajat Deo, MD, MTR Assistant Professor of Medicine Division of Cardiology, Electrophysiology Section University of Pennsylvania November
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 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 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 informationHypertension Management Controversies in the Elderly Patient
Hypertension Management Controversies in the Elderly Patient Juan Bowen, MD Geriatric Update for the Primary Care Provider November 17, 2016 2016 MFMER slide-1 Disclosure No financial relationships No
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 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 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 informationLeft Ventricular Hypertrophy New Insights
Left Ventricular Hypertrophy New Insights Athanasios J. Manolis MD, FACC, FESC, FAHA Director of Cardiology Dept, Asklepeion General Hospital, Athens Greece Overview Introduction and Factors promoting
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 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 informationEHRA/EUROPACE 2011 Madrid, Spain June
EHRA/EUROPACE 2011 Madrid, Spain June 26.-29.2011 Implementing modern management in atrial fibrillation patients Proceedings from the 3rd AFNet/EHRA consensus conference EHRA Special Session Different
More information1. Goette A, et al. J Am Coll Cardiol 2000;35:
Atrial Fibrillation: Upstream Therapies Gerald V. Naccarelli MD M.D. Research support: Boston-Scientific, Sanofi-Aventis, Boehringer-Ingelheim, Glaxo-Smith Smith-Kline Consultant: Glaxo-Smith Smith-Kline,
More informationThe RealiseAF registry:
The RealiseAF registry: An International, observational, cross-sectional survey evaluating atrial fibrillation management and the cardiovascular risk profile of AF patients initial results PG.Steg on behalf
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 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 informationAtrial Cardiomyopathy is it relevant?
Atrial Cardiomyopathy is it relevant? Dr Carl Shakespeare MD FRCP FACC FESC Consultant Cardiologist Relevance Progressive nature of AF Implications for RF Targeting Risk Factors CHADS vasc scoring? Could
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 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 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 informationACE 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 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 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 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 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 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 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 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 informationOutline. Pathophysiology: Heart Failure. Heart Failure. Heart Failure: Definitions. Etiologies. Etiologies
Outline Pathophysiology: Mat Maurer, MD Irving Assistant Professor of Medicine Definitions and Classifications Epidemiology Muscle and Chamber Function Pathophysiology : Definitions An inability of the
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 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 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 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 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 informationDECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST Is there a mortality risk associated with aspirin use in heart failure? Results from a large community based cohort Margaret Bermingham, Mary-Kate Shanahan, Saki Miwa,
More informationSamer Nasr, M.D. Mount Lebanon Hospital.
Samer Nasr, M.D. Mount Lebanon Hospital. Lone atrial fibrillation: Younger than 60 years old. No clinical or echo evidence of cardiopulmonary disease. Favorable prognosis. Thromboembolism usually not
More informationNew Strategies For Treating Patients With Chronic Heart Failure
New Strategies For Treating Patients With Chronic Heart Failure Barry Greenberg MD Professor of Medicine Director, Advanced Heart Failure Treatment Program University of California, San Diego Disclosures
More informationConsensus document: Screening and Prevention of Atrial Fibrillation
Consensus document: Screening and Prevention of Atrial Fibrillation Yong-Seog Oh, M.D.,Ph.D. Division of Cardiology, Department of Internal Medicine, Seoul St. Mary s Hospital, College of Medicine, The
More informationHypertension targets: sorting out the confusion. Brian Rayner, Division of Nephrology and Hypertension, University of Cape Town
Hypertension targets: sorting out the confusion Brian Rayner, Division of Nephrology and Hypertension, University of Cape Town Historical Perspective The most famous casualty of this approach was the
More informationPathophysiology: Heart Failure
Pathophysiology: Heart Failure Mat Maurer, MD Irving Assistant Professor of Medicine Outline Definitions and Classifications Epidemiology Muscle and Chamber Function Pathophysiology Heart Failure: Definitions
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 informationMetoprolol Succinate SelokenZOC
Metoprolol Succinate SelokenZOC Blood Pressure Control and Far Beyond Mohamed Abdel Ghany World Health Organization - Noncommunicable Diseases (NCD) Country Profiles, 2014. 1 Death Rates From Ischemic
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 informationRate and Rhythm Control of Atrial Fibrillation
Rate and Rhythm Control of Atrial Fibrillation April 21, 2017 춘계심혈관통합학술대회 Jaemin Shim, MD, PhD Arrhythmia Center Korea University Anam Hospital Treatment of AF Goal Reducing symptoms Preventing complication
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 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 informationHYPERTENSION AND HEART FAILURE
HYPERTENSION AND HEART FAILURE Kenya Cardiac Society Symposium Feb 2017 Dr Jeilan Mohamed No conflict of interests . Geoffrey, 45 yr old hypertensive office worker male from Nairobi, has just watched his
More informationManaging Hypertension in Diabetes Sean Stewart, PharmD, BCPS, BCACP, CLS Internal Medicine Park Nicollet Clinic St Louis Park.
Managing Hypertension in Diabetes 2015 Sean Stewart, PharmD, BCPS, BCACP, CLS Internal Medicine Park Nicollet Clinic St Louis Park Case Scenario Mike M is a 59 year old man with type 2 diabetes managed
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 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 informationAn Epidemiological Overview
An Epidemiological Overview Cardiovascular disease (CVD) is the leading cause of death in the U.S. In 2005 CVD accounted for approximately 38 percent of all deaths CVD has been the number one killer in
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 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 informationDiabetes and Hypertension
Diabetes and Hypertension William C. Cushman, MD, FAHA, FACP, FASH Chief, Preventive Medicine, Veterans Affairs Medical Center Professor, Preventive Medicine, Medicine, and Physiology University of Tennessee
More informationΜαρία Μαρκέτου Επιμ. Α Καρδιολογική Κλινική ΠαΓΝΗ
Μαρία Μαρκέτου Επιμ. Α Καρδιολογική Κλινική ΠαΓΝΗ Ischemic Heart Disease Mortality Rate in Each Decade of Age IHD mortality (floating absolute risk and 95% CI) 256 128 64 32 16 8 4 2 SBP 256 128 64 32
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 informationDiversity and HTN: Approaches to optimal BP control in AfricanAmericans
Diversity and HTN: Approaches to optimal BP control in AfricanAmericans Quinn Capers, IV, MD, FACC, FSCAI Assistant Professor of Medicine Associate Dean for Admissions Do Racial Differences Really Exist
More informationPrevention of Heart Failure: What s New with Hypertension
Prevention of Heart Failure: What s New with Hypertension Ali AlMasood Prince Sultan Cardiac Center Riyadh 3ed Saudi Heart Failure conference, Jeddah, 13 December 2014 Background 20-30% of Saudi adults
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 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 informationPreventing the cardiovascular complications of hypertension
European Heart Journal Supplements (2004) 6 (Supplement H), H37 H42 Preventing the cardiovascular complications of hypertension Peter Trenkwalder* Department of Internal Medicine, Starnberg Hospital, Ludwig
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationHypertension (JNC-8)
Hypertension (JNC-8) Southern California University of Health Sciences Physician Assistant Program Management and Treatment of Hypertension April 17, 2018, presented by Ezra Levy, Pharm.D.! The 8 th Joint
More informationHeart Failure with preserved ejection fraction (HFpEF)
Heart Failure with preserved ejection fraction (HFpEF) Dr. Pierpaolo Pellicori Hull York Medical School Kingston-upon-Hull United Kingdom Conflict of interest: none Heart failure is a contemporary problem
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 informationDisclosures. Speaker s bureau: Research grant: Advisory Board: Servier International, Bayer, Merck Serono, Novartis, Boehringer Ingelheim, Lupin
Disclosures Speaker s bureau: Research grant: Advisory Board: Servier International, Bayer, Merck Serono, Novartis, Boehringer Ingelheim, Lupin Servier International, Boehringer Ingelheim Servier International,
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 informationI have nothing to disclose.
I have nothing to disclose. Atrial fibrillation in octogenarians and beyond. The magnitude of the problem Etienne Aliot University of Nancy France Population ageing World Population Ageing 1950-2050 Age>
More informationBlood Pressure Monitoring in Chronic Kidney Disease
Blood Pressure Monitoring in Chronic Kidney Disease Aldo J. Peixoto, MD FASN FASH Associate Professor of Medicine (Nephrology), YSM Associate Chief of Medicine, VACT Director of Hypertension, VACT American
More informationHypertension Management: A Moving Target
9:45 :30am Hypertension Management: A Moving Target SPEAKER Karol Watson, MD, PhD, FACC Presenter Disclosure Information The following relationships exist related to this presentation: Karol E. Watson,
More information