Clinical cases with Coversyl 10 mg
|
|
- Blake Richards
- 6 years ago
- Views:
Transcription
1 Clinical cases Coversyl 10 mg For upgraded benefits in hypertension A
2 Editorial This brochure, Clinical cases Coversyl 10 mg for upgraded benefits in hypertension, illustrates a variety of hypertensive patients you may encounter and shows how effective Coversyl 10 mg is at reducing blood pressure and cardiovascular complications in these types of patient. Throughout this issue, you will discover why Coversyl up to 10 mg holds a privileged position among antihypertensive drugs, both as a monotherapy and as an alternative to other therapies. This brochure presents reports on 5 patients from real-life clinical practice and explains the most appropriate therapeutic strategies according to evidence-based medicine. We hope you will appreciate this brochure, which will not only provide you valuable scientific information, but also advice and practical guidance for improving the management of hypertension Coversyl 10 mg.
3 Contents SOMMAIRE 1 A newly diagnosed patient p 2 2 A hypertensive patient p 4 newly diagnosed patient 3 A hypertensive patient p 6 on an ACE inhibitor 4 A hypertensive patient p 8 dyslipidemia dyslipidemia 5 A hypertensive patient p 10 coronary artery disease coronary artery disease Note: This brochure presents results expressed Coversyl arginine (5 or 10 mg/day), which is bioequivalent to Coversyl 4 or 8 mg/day (perindopril tert-butylamine). 1
4 1. A newly diagnosed hypertensive patient The CONFIDENCE Study: This study is the first demonstration of the antihypertensive benefits of uptitration to perindopril 10 mg/day* in hypertensive patients out CAD. Therefore, uptitration to the full dose of perindopril may be considered as an effective approach for improving the management of hypertensive patients. Tsoukas G et al. Am J Cardiovasc Drugs. 2011; 11 (1): Case report Man 53 years old Relatively marked obesity: weight 105 kg, height 185 cm (body mass index 30 kg/m 2 ) Smoker (one cigar every evening) Little physical activity At a recent visit to the doctor for episodes of insomnia, the general practitioner noted a high blood pressure of 160/102 mm Hg. The rest of the examination was normal. A complete examination was ordered because of these BP values, his obesity, and his moderate smoking. The examination was intended to confirm the existence of high blood pressure, determine other risk factors, and assess possible consequences of the high blood pressure, whose precise duration was not known. The examination Laboratory tests Cholesterol was in the normal range, but blood sugar was 1.15 g/l (6.38 mmol/l). Electrocardiogram Sinus rhythm of 66 beats/min PR interval = 0.16 sec QRS axis =+ 70 Normal ventricular repolarization Comments This patient has systolic-diastolic high blood pressure and two risk factors, obesity and moderate smoking. In addition, his blood sugar is considered to be at the limit of normal. Antihypertensive treatment involves proposing a therapeutic class to this patient that offers BPlowering efficacy and protection of target organs. It was recommended that the patient lose weight, take regular physical exercise (1 hour of walking a day), and stop smoking. Quarterly surveillance measurement of blood pressure and a plasma glucose assay was also advised. Therapeutic objective: Choose an appropriate first-line therapy Choose the right dose Control BP SBP <140 mm Hg and DBP < 90 mm Hg Reduce risk of cardiovascular events and mortality Why Coversyl 10 mg? 1. ACE inhibitors: a first-choice option in young hypertensive patients The joint BHS/NICE guidelines for the treatment of hypertension were updated and now recommend that in newly diagnosed patients under 55 years of age, an ACE inhibitor be used as the first-line treatment (Figure 1). 1 NCGC/NICE 2011 hypertension guidelines < 55 yrs 55 yrs or any age if black A* C A* + C A* + C + D Consider 4th-line drug a-blocker further diuretic therapy β-blocker consider seeking specialist advice A = ACE inhibitor or low cost ARB (*consider ARB if ACE inhibitor intolerant) C = calcium channel blocker D = thiazide-like diuretic (e.g. indapamide or chlorthalidone, instead of hydrochlorothiazide) Figure 1. ACE inhibitors are recommended as the first-choice treatment in young hypertensive patients. NCGC/NICE 2011 guidelines in clinical management of primary hypertension in adults (NCGC: National Clinical Guidelines Center, NICE: National Institute for Health and Clinical Excellence). 2 *Results expressed Coversyl arginine 10 mg/day, which is bioequivalent to Coversyl tert-butylamine 8 mg/day used in the CONFIDENCE study.
5 2. Objective: full-dose monotherapy 10 mg Recently, a large survey of treated hypertensive patients followed by non-specialist or specialist physicians was carried out in central and eastern European countries. Results of this study, called the Blood Pressure control rate and CardiovAscular Risk profile (BP-CARE) study, provided do not differ from those seen in Western Europe. This study assessed the proportion of risk factors associated hypertension to quantify total CV risk. It shows that in real-life clinical practice, about 70% of hypertensive patients had a very high-risk profile a combination of 1 or more risk factors (Figure 2). 2 Main risk factors % Total cholesterol (>200 mg/dl) 59.3% Visceral obesity (M>102 cm, W>88 cm) 47.2% Age (M>55yrs, W>65yrs) 46.3% Metabolic syndrome 40.4% Low HDL (M<40, W<50 mg/dl) 30.4% 3. Dose-dependent efficacy of Coversyl 10 mg In the CONFIDENCE trial, 4 conducted in 8298 hypertensive patients of whom 56% were newly diagnosed patients, uptitration to Coversyl 10 mg was shown to provide superior blood pressure-lowering efficacy. In this untreated population, Coversyl 5 to 10 mg significantly decreased blood pressure by 21.5/11.5 mm Hg from baseline (P<0.001) (Figure 4). In the overall population, mean blood pressure decreased significantly from baseline by 18.5/9.7 mm Hg over 12 weeks (P<0.001). At the second visit, uptitration to Coversyl 10 mg provided an additional mean 10.1/5.3 mm Hg blood pressure reduction. Therefore, uptitration to Coversyl 10 mg is an effective approach for superior blood pressure-lowering efficacy, especially when concomitant risk factors are present. 0-5 Newly diagnosed patients treated Coversyl (n=4617) Further BP efficacy when Coversyl is uptitrated from 5 mg to 10 mg (n=1943) 0 SOMMAIRE newly diagnosed patient Smoking 15.1% Stroke 11.5% -11* -5-5 Figure 2. Most hypertensive patients have associated risk factors. Blood Pressure control rate and CardiovAscular Risk profile (BP-CARE) study The latest guidelines for the management of arterial hypertension from the ESH/ESC state that in cases of mild BP elevation 1 or 2 risk factors, treatment can start a single drug, initially at low dose, the possibility of uptitrating to the full dose of the same agent (Figure 3). 3 Therefore, using the full dose of Coversyl 10 mg is a reasonable option in this patient hypertension associated risk factors (ob esity, smoking). Mild BP elevation Low/moderate CV risk Conventional BP target Single agent at low dose * -25 Further BP decrease (mm Hg) SBP DBP 4. Provide lifesaving benefits In the ASCOT trial, 5 20% of the hypertensive patients were newly diagnosed. Amlodipine + Coversyl, in comparison a β-blocker + diuretic, significantly reduced total mortality by 11%, cardiovascular mortality by 24%, fatal and nonfatal stroke by 23%, and new-onset diabetes by 30%. Further BP decrease (mm Hg) SBP DBP Figure 4. Uptitration to Coversyl 10 mg provides further blood pressure-lowering efficacy dyslipidemia coronary artery disease Previous agent at full dose Two- to three-drug combination at full doses Switch to different agent at low dose Full-dose monotherapy If goal BP not achieved If goal BP not achieved Figure 3. Full-dose monotherapy option. Adapted from the 2007 guidelines for the management of arterial hypertension from the ESH/ ESC. 3 What to do for this newly diagnosed patient? Lifestyle modifications: Weight control, physical exercise, stop smoking. Laboratory parameters: Glycemia Clinical management: Introduce Coversyl 5 mg and uptitrate to Coversyl 10 mg after 1 month (for greater arterial protection or if blood pressure target is not achieved). 3
6 2. A hypertensive patient Perindopril-based regimens were associated a statistically significant reduction in all-cause mortality (HR, 0.87; 95% CI, 0.81 to 0.94; P<0.0001), whereas the remaining ACE inhibitors were not. No significant reduction in all-cause mortality could be demonstrated ARBs. Meta-analysis on all-cause mortality in hypertension trials: Bertrand ME et al. Eur Heart J. 2011;Vol.32(Abstract Supplement):13. Case report Man 54 years old No particular cardiovascular history, either personal or family Travels a lot in Europe Treated losartan 50 mg/day in the morning for 2 years. He has experienced recent episodes of asthenia, for which he has been seeing a doctor. He has no suggestive symptoms or signs. Blood pressure values 1 month apart revealed high systolic blood pressure diastolic pressure at the upper normal limit (158/85 mm Hg). The rest of the clinical examination was normal. The examination Laboratory tests Total cholesterol: 156 mg/dl (4.02 mmol/l) HDL cholesterol: 37 mg/dl (0.95 mmol/l) LDL cholesterol: 107 mg/dl (2.74 mmol/l) Plasma glucose: 91 mg/dl (5.05 mmol/l) Electrocardiogram Sinus rhythm of 80 beats/min PR interval = 0.14 sec QRS axis = - 10 Normal repolarization Comments This patient continues to have high blood pressure in spite of treatment losartan, which suggests that his medical treatment should be reconsidered and that regular physical exercise and a healthy diet be recommended. Therapeutic objective: Provide further BP-lowering efficacy Control BP SBP <140 mm Hg and DBP <90 mm Hg Ensure 24-hour BP control Provide cardiovascular protection (evidencebased medicine) and lifesaving benefits Why Coversyl 10 mg? 1. Switch to the right dose of Coversyl In patients, it is usual to add a thiazide diuretic and then prescribe a fixeddose ARB/hydrochlorothiazide combination. This is easy to do, but are optimal efficacy and cardiovascular protection actually provided? Recent data showed that the use of a diuretic such as hydrochlorothiazide (HCTZ) could increase the risk of new-onset diabetes 1 or lead to a higher risk of events. 2,3 In this particular clinical case, the renin-angiotensin system has been inhibited by the ARB losartan, but the BP of this patient is not controlled by this agent anymore. One of the options from the latest guidelines for the management of arterial hypertension from the ESH/ESC states that it is reasonable to switch to another agent, at the full monotherapy dose of this agent, if the BP goal is not achieved. 4 Unlike ARBs, by simultaneously inhibiting the interaction of angiotensin II its different receptors (AT1, AT2, AT4) and by increasing levels of circulating bradykinin, Coversyl provides a more complete mode of action to inhibit the renin-angiotensin system. This increased level of circulating bradykinin may explain Coversyl s additional benefits in terms of cardiovascular protection. Therefore, losartan treatment could be switched to Coversyl (up to 10 mg) for further blood pressure-lowering efficacy and proven cardiovascular benefits (the dose of Coversyl should be individualized according to the patient profile and blood pressure response). 2. Further BP-lowering efficacy In the CONFIDENCE trial, hypertensive patients on other ACE inhibitors or sartans were switched to Coversyl, and uptitrated to 10 mg if necessary. 5 In this everyday hypertensive population, Coversyl provided a further 16/8 mm Hg BP decrease in patients after switching from a sartan (Figure 1). Therefore, Coversyl, up to a dose of 10 mg, is an excellent choice for patients on sartans. 4
7 ARBs Irbesartan Further BP decrease (mm Hg) Switch from Valsartan to COVERSYL -15 SBP Losartan Ensure 24-hour BP control BP: blood pressure; SBP: systolic blood pressure; DBP: diastolic blood pressure Compared the main ARBs, Coversyl has a high T:P ratio (Trough to Peak ratio= 75%- 100%), leading to proven 24-h efficacy and BP control (Figure 2). 6-6 Telmisartan n 1774 Figure 1. The CONFIDENCE Trial. Coversyl further decreased blood pressure in hypertensive patients on sartans. DBP the risk of stroke and heart failure, they have no significant impact on myocardial infarction and mortality reduction when compared placebo or active treatments. In contrast, a combined analysis of individual data from ADVANCE, EUROPA, and PROGRESS showed that a Coversyl-based regimen significantly and consistently reduced major cardiovascular events, such as mortality, stroke, and also MI (Figure 3) Provide lifesaving benefits A recent meta-analysis evaluated the impact of RAAS inhibitors on further mortality reduction for their main indication, hypertension. 10 This metaanalysis included patients treated either ACE inhibitors or ARBs for a mean follow-up of 4.1 years. Nearly all (92%) of the trial participants were hypertensive a mean baseline systolic BP of 153 mm Hg. SOMMAIRE newly diagnosed patient Coversyl 24-h efficacy evaluated by T/P ratio T/P ratio (%) 750% Losartan Irbesartan Valsartan Time (h) 58-78% 50-60% 69-76% Figure 2. Compared the main ARBs, Coversyl has an optimal T:P ratio. 4. Provide cardiovascular protection High-risk period for MI stroke Figure 3. Coversyl-based regimens reduce major cardiovascular events in patients vascular disease. With ARBs, there is conflicting evidence regarding the risk of myocardial infarction (MI), the so-called MI paradox. 7 Following publication of this article, further ARB trials were performed. Professors Messerli & Bangalore conducted a new metaanalysis to evaluate the cardiovascular outcomes, notably MI, associated ARBs. 8 This metaanalysis confirmed that if ARBs significantly reduce Figure 4. Impact of antihypertensive treatments on mortality reduction showing the significant benefit of Coversyl-based regimens. This meta-analysis showed that Coversylbased regimens further decrease mortality by a significant 13% (P<0.001) (Figure 4). In contrast, in this meta-analysis, ARB results showed no significant impact on total mortality. In conclusion, by further decreasing the risk of total mortality compared other agents, Coversyl provides unique lifesaving benefits. What to do for this patient? Clinical management: In this clinical case, although the renin-angiotensin system was already being inhibited by the ARB losartan, the results were inadequate. It was possible to switch from losartan treatment to Coversyl 10 mg once daily for greater BP control (the dose should be individualized according to the patient profile and blood pressure response). Lifestyle modifications: Physical exercise, balanced diet. dyslipidemia coronary artery disease 5
8 3. A hypertensive patient on an ACE inhibitor The PREFER Study: Perindopril 5 10 mg/day lowers blood pressure and pulse pressure and improves blood pressure control among hypertensive patients who were previously unresponsive to other ACE inhibitor-based regimens. Ionescu DD et al. Clin Drug Investig. 2009; 29 (12): Choosing correct dosages to ensure effective and homogeneous 24-hour BP reduction. The Correct Administration of Antihypertensive Drugs. Taddei S et al. Am J Cardiovasc Drugs. 2011; 11 (1): Case report Woman 53 years old Still active, but sometimes she experienced considerable fatigue a sensation of tachycardia, but no suspicious chest pain Mild-to-moderate high blood pressure No other coronary risk factors Treated ramipril 10 mg/day No other treatment. Cardiac auscultation revealed a very discreet systolic murmur from a mitral insufficiency diagnosed some time ago. In spite of treatment ramipril, her blood pressure values remained high at 156/88 mm Hg. The examination Electrocardiogram sinus rhythm of 75 beats/min, PR interval = 0.20 sec QRS axis = +25 Normal repolarization Ultrasonography Heart volume: normal a conserved ejection fraction Grade I mitral insufficiency in the left atrium in normal limits. No pulmonary hypertension. This ultrasonography was identical to one conducted 2 years before. Comments The symptomatology of this patient is unrelated to her mitral insufficiency, which does not involve the heart or lungs. Her symptoms might result from increased pressure values that can be managed by changing the angiotensin-converting enzyme inhibitor and possibly adding a calcium channel blocker or a diuretic if possible. Therapeutic objective: Provide further BP-lowering efficacy Control BP SBP <140 mm Hg and DBP <90 mm Hg Ensure 24-hour BP control Provide cardiovascular protection (evidencebased medicine) and lifesaving benefits Why Coversyl 10 mg? 1. Change to another ACE inhibitor In young hypertensive patients under 55 years old, guidelines recommend ACE inhibitors as a first-line option. 1 This patient is on ramipril, therefore it would be useful to change from this to another ACE inhibitor that simultaneously provides further blood pressurelowering efficacy, 24-h blood pressure control, and cardiovascular protection. Figure 1. The PREFER Trial. Coversyl further decreased blood pressure in hypertensive patients on other ACE inhibitors. In the PREFER study, 2 the antihypertensive efficacy of Coversyl 5 and 10 mg was evaluated in 824 hypertensive patients inadequately controlled on previous treatment ACE inhibitors. They were receiving an ACE inhibitor as monotherapy (21.5%) or in combination (78.5%) β-blockers, diuretics, or CCBs. At 3 months, the switch 6
9 to Coversyl (up to 10 mg in 57% of patients) provided an additional reduction in blood pressure of -26/-13 mm Hg, whatever the ACE inhibitor initially prescribed at usual dosage (Figure 1). Therefore, the PREFER trial shows that choosing Coversyl, at a dose up to 10 mg, is a valuable option in patients on other ACE inhibitors. 2. Ensure 24-hour BP control and optimal ACE inhibition There is no class effect among ACE inhibitors. They are commonly believed to be similar, as they all belong to the same class of drugs. However, although all ACE inhibitors inhibit the angiotensinconverting enzyme and decrease blood pressure, they also present many pharmacokinetic and pharmacodynamic differences Coversyl has very high and long-lasting tissue ACE affinity, a very high bradykinin/angiotensin ratio, as well as the best 24-hour BP control (Figure 2). 3-7 Tissue ACE affinity 3 (Tissue potency DD50) Bradykinin 4 /angiotensin ratio 24-hour efficacy 5-7 (T/P ratio) Coversyl %0% Quinapril Ramipril % % Trandolapril NA % Enalapril % Figure 3. Impact of antihypertensive treatments on mortality reduction showing the significant benefit of Coversyl-based regimens. Although the HOPE study has shown that ramipril significantly reduced the primary end point (MI, stroke, and death from CV causes) in highrisk cardiac patients, the HOPE study was not selected in this meta-analysis as less than 66% of patients were hypertensive (only 47% of the population was hypertensive in the HOPE trial). Overall, this meta-analysis also shows that there is no class effect for ACE inhibitors to further reduce mortality in hypertensive patients. The authors concluded that Coversyl-based regimens further decrease mortality by a significant 13% (P<0.001) (Figure 3). In contrast, in this meta-analysis, results other ACE inhibitors showed no significant impact on total mortality. Therefore, Coversyl provides unique lifesaving benefits by further decreasing the risk of total mortality compared to other ACE inhibitors. SOMMAIRE newly diagnosed patient dyslipidemia Figure 2. Comparison of ACE inhibitor characteristics. In addition, Coversyl has an excellent tolerability profile, a very low rate of cough that is not dose-dependent. 8 A recent meta-analysis involving patients from 125 ACE inhibitor trials reported the lowest incidence of cough for Coversyl of the 9 main ACE inhibitors (including ramipril, benazepril, enalapril, etc.) observed Provide lifesaving benefits in hypertension A recent meta-analysis evaluated the impact of RAAS inhibitors on further mortality reduction for their main indication, hypertension. 10 This meta-analysis included patients treated either ACE inhibitors or ARBs for a mean follow-up period of 4.1 years. Nearly all (92%) of the trial participants were hypertensive (inclusion criteria: >66% of patients had hypertension), a mean baseline systolic BP of 153 mm Hg. What to do for this patient? Clinical management: In this clinical case, the renin-angiotensin system was already being inhibited by the ACE inhibitor ramipril, at the maximum dose of 10 mg. Therefore, one could switch from ramipril 10 mg directly to Coversyl 10 mg once daily (eventually, if blood pressure control is insufficient, add a calcium channel blocker or a diuretic, such as indapamide SR, according to NICE/BHS recommendations). coronary artery disease 7
BLOOD 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 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 informationManagement of Hypertension
Clinical Practice Guidelines Management of Hypertension Definition and classification of blood pressure levels (mmhg) Category Systolic Diastolic Normal
More informationBy Prof. Khaled El-Rabat
What is The Optimum? By Prof. Khaled El-Rabat Professor of Cardiology - Benha Faculty of Medicine HT. Introduction Despite major worldwide efforts over recent decades directed at diagnosing and treating
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 informationThe legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 7 January 2009
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 7 January 2009 LERCAPRESS 10 mg/10 mg, film-coated tablets Pack of 30 (CIP code: 385 953-3) Pack of 90 (CIP code:
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 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 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 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 informationHypertension in the Elderly. John Puxty Division of Geriatrics Center for Studies in Aging and Health, Providence Care
Hypertension in the Elderly John Puxty Division of Geriatrics Center for Studies in Aging and Health, Providence Care Learning Objectives Review evidence for treatment of hypertension in elderly Consider
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 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 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 informationHigh-dose monotherapy vs low-dose combination therapy of calcium channel blockers and angiotensin receptor blockers in mild to moderate hypertension
(2005) 19, 491 496 & 2005 Nature Publishing Group All rights reserved 0950-9240/05 $30.00 www.nature.com/jhh ORIGINAL ARTICLE High-dose monotherapy vs low-dose combination therapy of calcium channel blockers
More informationJNC Evidence-Based Guidelines for the Management of High Blood Pressure in Adults
JNC 8 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults Table of Contents Why Do We Treat Hypertension? Blood Pressure Treatment Goals Initial Therapy Strength of Recommendation
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 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 informationThiazide or Thiazide Like? Choosing Wisely Academic Detailing Conference Digby Pines October 12-14
Thiazide or Thiazide Like? Choosing Wisely Academic Detailing Conference Digby Pines October 12-14 Disclosures Pam McLean-Veysey, Team Leader Drug Evaluation Unit DEU funded by the Drug Evaluation Alliance
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 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 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 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 informationCombination therapy Giuseppe M.C. Rosano, MD, PhD, MSc, FESC, FHFA St George s Hospitals NHS Trust University of London
Combination therapy Giuseppe M.C. Rosano, MD, PhD, MSc, FESC, FHFA St George s Hospitals NHS Trust University of London KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833 803 Email:
More informationWhich antihypertensives are more effective in reducing diastolic hypertension versus systolic hypertension? May 24, 2017
Which antihypertensives are more effective in reducing diastolic hypertension versus systolic hypertension? May 24, 2017 The most important reason for treating hypertension in primary care is to prevent
More informationALLHAT. Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic
1 U.S. Department of Health and Human Services National Institutes of Health Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker
More informationDISCLOSURE PHARMACIST OBJECTIVES 9/30/2014 JNC 8: A REVIEW OF THE LONG-AWAITED/MUCH-ANTICIPATED HYPERTENSION GUIDELINES. I have nothing to disclose.
JNC 8: A REVIEW OF THE LONG-AWAITED/MUCH-ANTICIPATED HYPERTENSION GUIDELINES Tiffany Dickey, PharmD Assistant Professor, UAMS COP Clinical Pharmacy Specialist, Mercy Hospital Northwest AR DISCLOSURE I
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 informationVal-MARC: Valsartan-Managing Blood Pressure Aggressively and Evaluating Reductions in hs-crp
Página 1 de 5 Return to Medscape coverage of: American Society of Hypertension 21st Annual Scientific Meeting and Exposition Val-MARC: Valsartan-Managing Blood Pressure Aggressively and Evaluating Reductions
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 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 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 informationManaging hypertension: a question of STRATHE
(2005) 19, S3 S7 & 2005 Nature Publishing Group All rights reserved 0950-9240/05 $30.00 www.nature.com/jhh ORIGINAL ARTICLE Managing hypertension: a question of STRATHE Department of Cardiovascular Disease,
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 informationHeart Failure Clinician Guide JANUARY 2018
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Heart Failure Clinician Guide JANUARY 2018 Introduction This evidence-based guideline summary is based on the 2018 National Heart Failure Guideline.
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 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 informationAntihypertensive Agents Part-2. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia
Antihypertensive Agents Part-2 Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Agents that block production or action of angiotensin Angiotensin-converting
More informationIn the Literature 1001 BP of 1.1 mm Hg). The trial was stopped early based on prespecified stopping rules because of a significant difference in cardi
Is Choice of Antihypertensive Agent Important in Improving Cardiovascular Outcomes in High-Risk Hypertensive Patients? Commentary on Jamerson K, Weber MA, Bakris GL, et al; ACCOMPLISH Trial Investigators.
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 informationClinical Recommendations: Patients with Periodontitis
The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease. Friedewald VE, Kornman KS, Beck JD, et al. J Periodontol 2009;
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 informationAbbreviations Cardiology I
Cardiology I and Clinical Controversies Joseph J. Saseen, Pharm.D., FCCP, BCPS (AQ Cardiology) Reviewed by Stuart T. Haines, Pharm.D., FCCP, BCPS; and Michelle M. Richardson, Pharm.D., FCCP, BCPS Learning
More information2003 World Health Organization (WHO) / International Society of Hypertension (ISH) Statement on Management of Hypertension.
2003 World Health Organization (WHO) / International Society of Hypertension (ISH) Statement on Management of Hypertension Writing Group: Background Hypertension worldwide causes 7.1 million premature
More informationHypertension and Cardiovascular Disease
Hypertension and Cardiovascular Disease 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 means graphic,
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 information5.2 Key priorities for implementation
5.2 Key priorities for implementation From the full set of recommendations, the GDG selected ten key priorities for implementation. The criteria used for selecting these recommendations are listed in detail
More information4/4/17 HYPERTENSION TARGETS: WHAT DO WE DO NOW? SET THE STAGE BP IN CLINICAL TRIALS?
HYPERTENSION TARGETS: WHAT DO WE DO NOW? MICHAEL LEFEVRE, MD, MSPH PROFESSOR AND VICE CHAIR DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE UNIVERSITY OF MISSOURI 4/4/17 DISCLOSURE: MEMBER OF THE JNC 8 PANEL
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 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 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 informationModule 3.2. Management of hypertension at primary health care
Module 3.2 Management of hypertension at primary health care What s inside Introduction Learning outcomes Topics covered Competency Teaching and learning activities Background information Introduction
More informationThe hypertensive effects of the renin-angiotensin
Comparison of Telmisartan vs. Valsartan in the Treatment of Mild to Moderate Hypertension Using Ambulatory Blood Pressure Monitoring George Bakris, MD A prospective, randomized, open-label, blinded end-point
More informationModule 2. Global Cardiovascular Risk Assessment and Reduction in Women with Hypertension
Module 2 Global Cardiovascular Risk Assessment and Reduction in Women with Hypertension 1 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored,
More informationHypertension and obesity. Dr Wilson Sugut Moi teaching and referral hospital
Hypertension and obesity Dr Wilson Sugut Moi teaching and referral hospital No conflict of interests to declare Obesity Definition: excessive weight that may impair health BMI Categories Underweight BMI
More informationManaging HTN in the Elderly: How Low to Go
Managing HTN in the Elderly: How Low to Go Laxmi S. Mehta, MD, FACC The Ohio State University Medical Center Assistant Professor of Clinical Internal Medicine Clinical Director of the Women s Cardiovascular
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 informationAdapted d from Federation of Health Regulatory Colleges of Ontario Template Last Updated September 18, 2017
Insert Logo or Org Name Here Primary Care Medical Directive for Hypertension Management Adapted d from Federation of Health Regulatory Colleges of Ontario Template Last Updated September 18, 2017 Title:
More informationYounger adults with a family history of premature artherosclerotic disease should have their cardiovascular risk factors measured.
Appendix 2A - Guidance on Management of Hypertension Measurement of blood pressure All adults from 40 years should have blood pressure measured as part of opportunistic cardiovascular risk assessment.
More informationTalking about blood pressure
Talking about blood pressure Mrs Khan 56 BP 158/99 BMI 32 Total cholesterol 5.4 (HDL 0.8) HbA1c 43 She has been promising to do more exercise and eat more healthily for the last 2 years but her weight
More informationDisclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease
Disclosures Diabetes and Cardiovascular Risk Management Tony Hampton, MD, MBA Medical Director Advocate Aurora Operating System Advocate Aurora Healthcare Downers Grove, IL No conflicts or disclosures
More informationThe legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 27 May 2009
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 27 May 2009 RASILEZ HCT 150 mg/12.5 mg, film-coated tablets B/30 (CIP code: 392 151-6) RASILEZ HCT 150 mg/25 mg, film-coated
More informationVA/DoD Clinical Practice Guideline for the Diagnosis and Management of Hypertension - Pocket Guide Update 2004 Revision July 2005
VA/DoD Clinical Practice Guideline for the Diagnosis and Management of Hypertension - Pocket Guide Update 2004 Revision July 2005 1 Any adult in the health care system 2 Obtain blood pressure (BP) (Reliable,
More informationCauses of Poor BP control Rates
Goals Of Hypertension Management in Clinical Practice World Hypertension League (WHL) Meeting Adel E. Berbari, MD, FAHA, FACP Professor of Medicine and Physiology Head, Division of Hypertension and Vascular
More informationFirst line treatment of primary hypertension
First line treatment of primary hypertension Dr. Vijaya Musini Assistant Professor, Dept. Anesthesiology, Pharmacology and Therapeutics Manager, Drug Assessment Working Group Therapeutics Initiative Editor,
More informationRandomized Design of ALLHAT BP Trial
Outcomes in Hypertensive Black and Nonblack Patients Treated with Chlorthalidone, Amlodipine, and Lisinopril* *Wright JT, Dunn JK, Cutler JA et al. JAMA 2005:293:1595-1608. 42,418 High-risk hypertensive
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 informationHypertension Update. Sarah J. Payne, MS, PharmD, BCPS Assistant Professor, Department of Pharmacotherapy UNT System College of Pharmacy
Hypertension Update Sarah J. Payne, MS, PharmD, BCPS Assistant Professor, Department of Pharmacotherapy UNT System College of Pharmacy Introduction 1/3 of US adults have HTN More prevalent in non-hispanic
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 informationThe Indian Polycap Study 1 & 2 (TIPS 1 & 2) and The International Polycap Study 3 & 4 (TIPS 3 & 4)
The Indian Polycap Study 1 & 2 (TIPS 1 & 2) and The International Polycap Study 3 & 4 (TIPS 3 & 4) Denis Xavier MD, MSc Professor and Head, Pharmacology, St. John's Medical College Coordinator, Division
More informationHow Low Do We Go? Update on Hypertension
How Low Do We Go? Update on Beth L. Abramson, MD, FRCPC, FACC As presented at the University of Toronto s Saturday at the University Session (September 2003) Arecent World Health Organization report states
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 informationDon t let the pressure get to you:
Balanced information for better care Don t let the pressure get to you: Current evidence-based goals for treating hypertension A cornerstone of primary care: Lowering high blood pressure prevents cardiovascular
More informationThe Latest Generation of Clinical
The Latest Generation of Clinical Guidelines: HTN and HLD Dave Brackett Clinical Guideline Purpose Uniform approach Awareness of key details Diagnosis Treatment Monitoring Evidence based approach Inform
More informationIs there a mechanism of interaction between hypertension and dyslipidaemia?
Is there a mechanism of interaction between hypertension and dyslipidaemia? Neil R Poulter International Centre for Circulatory Health NHLI, Imperial College London Daegu, Korea April 2005 Observational
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 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 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 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 High Blood Pressure in Adults
Management of High Blood Pressure in Adults Based on the Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC8) James, P. A. (2014, February 05). 2014 Guideline for Management
More informationExplore the Rationale for the Dual Mechanism CCB/ARB Approach in Hypertension Management
Explore the Rationale for the Dual Mechanism CCB/ARB Approach in Hypertension Management Jeong Bae Park, MD,PhD Dept of Med/Cardiology, Cheil General Hospital, Kwandong University College of Medicine Apr
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 informationAmerican Diabetes Association 2018 Guidelines Important Notable Points
American Diabetes Association 2018 Guidelines Important Notable Points The Standards of Medical Care in Diabetes-2018 by ADA include the most current evidencebased recommendations for diagnosing and treating
More informationSummary of recommendations
Summary of recommendations Measuring blood pressure (BP) Use the recommended technique at every BP reading to ensure accurate measurements and avoid common errs. Pay particular attention to the following:
More informationHypertension in 2015: SPRINT-ing ahead of JNC-8. MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic
Hypertension in 2015: SPRINT-ing ahead of JNC-8 MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic Conflits of interest? None Disclaimer The opinions contained herein are not to be considered
More informationAntihypertensive efficacy of olmesartan compared with other antihypertensive drugs
(2002) 16 (Suppl 2), S24 S28 2002 Nature Publishing Group All rights reserved 0950-9240/02 $25.00 www.nature.com/jhh compared with other antihypertensive drugs University Clinic Bonn, Department of Internal
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 informationObjectives. Describe results and implications of recent landmark hypertension trials
Hypertension Update Daniel Schwartz, MD Assistant Professor of Medicine Associate Medical Director of Heart Transplantation Temple University School of Medicine Disclosures I currently have no relationships
More informationDon t let the pressure get to you:
Balanced information for better care Don t let the pressure get to you: An update on the changing recommendations for treating hypertension New trial data and guidelines have made hypertension care more
More informationCADTH CANADIAN DRUG EXPERT COMMITTEE FINAL RECOMMENDATION
CADTH CANADIAN DRUG EXPERT COMMITTEE FINAL RECOMMENDATION PERINDOPRIL ARGININE/AMLODIPINE (Viacoram Servier Canada Inc.) Indication: Mild to Moderate Essential Hypertension Recommendation: The Canadian
More information2/10/2014. Hypertension: Highlights of Hypertension Guidelines: Making the Most of Limited Evidence. Issues with contemporary guidelines
Hypertension: 214 Highlights of Hypertension Guidelines: Making the Most of Limited Evidence Michael A, Weber, MD Editor-in-Chief, The Journal of Clinical Hypertension, Professor of Medicine, Division
More informationUnderstanding the importance of blood pressure control An overview of new guidelines: How do they impact daily current management?
Understanding the importance of blood pressure control An overview of new guidelines: How do they impact daily current management? Slides presented during CDMC in Almaty, Kazakhstan on Saturday April 12,
More informationDisclosures. Hypertension: Nationwide Dilemma. Learning Objectives. What s Currently Recommended? Specific Concerns 3/9/2012
How Should We ACCOMPLISH Good Blood Pressure Control In Our VETS? Disclosures No conflicts of interest to disclose Updates in the Management of HypertensionIn the Elderly Antoine T. Jenkins, Pharm.D.,
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 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 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 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 informationAdult Blood Pressure Clinician Guide June 2018
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Adult Blood Pressure Clinician Guide June 2018 Adult Blood Pressure Clinician Guide June 2018 Introduction This Clinician Guide is based on the 2018
More informationACE inhibitors vs ARBs Myths and Facts
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,
More informationThe underestimated risk of
Earn 3 CPD Points online The underestimated risk of hypertension Dr David Webb Johannesburg Introduction The high and increasing worldwide burden of hypertension is a major global health challenge. Hypertension
More information