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Alad PAO, Punzalan FER, Llanes EJB, Aherrera JAM, Gervacio GG, Reyes EB, Anonuevo JC. Cardiovascular profile and electrocardiographic findings of hospitalized adult patients during the surge of delta and omicron variants of COVID-19 in a COVID-19 tertiary referral center. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
COVID-19 has been reported to cause cardiac injury. It can be detected by an electrocardiogram (ECG), which may show markers that may predict clinical outcome. Robust data on the ECG abnormalities among COVID-19 patients affected by the alpha, beta, and gamma variants have been reported, but there is paucity of data among patients affected by the delta and omicron variants.
Purpose
This study aims to describe the cardiovascular profile, ECG findings, and clinical course of adult patients with COVID-19, and to determine the association between certain ECG findings and clinical outcomes among these patients.
Methods
We evaluated 547 COVID-19 patients admitted from June 2021 to June 2022. Clinical profiles were extracted from electronic records. Admission ECGs were independently read and adjudicated by three cardiologists. Logistic regression analysis was done to determine the association between ECG abnormalities and adverse outcomes, including in-hospital mortality, ICU admission, need for mechanical ventilation, acute respiratory distress syndrome (ARDS), shock, acute kidney injury (AKI), myocardial infarction (MI), myocarditis, venous thromboembolism (VTE), and stroke.
Results
A Total of 547 COVID-19 patients (mean age 54; men 51.2%) were included. The most common comorbidities were hypertension, diabetes, and dyslipidemia. Majority of patients had severe COVID-19 infection (36%). On admission, 6.4% needed intubation and 14.6% died. The most common ECG abnormalities were non-specific ST-T wave changes (41.1%) and sinus tachycardia (25.6%). Other findings were ST segment depression (3.3%), T wave inversion (1.6%), and ST segment elevation (1.3%). On logistic regression analysis, intraventricular conduction delay (IVCD), T wave inversion, and poor R wave progression were significantly associated with mortality; sinus tachycardia, atrioventricular (AV) block, ST segment elevation, and T wave inversion were significantly associated with the development of VTE; left axis deviation, ST segment elevation, and T wave inversion were significantly associated with the development of ARDS; sinus tachycardia, ST segment depression, and T wave inversion were significantly associated with the development of shock; and sinus tachycardia, ST segment elevation, and early repolarization changes were significantly associated with ICU admission. No associations were established for AKI, MI, myocarditis, and need for mechanical ventilation due to the low prevalence of these outcomes.
Conclusion
A baseline ECG in patients with COVID-19 may help predict patients who may warrant hospitalization or even intensive care monitoring. In our cohort, certain ECG abnormalities, especially sinus tachycardia, left axis deviation, ST segment elevation, ST segment depression, T wave inversion, AV block, IVCD, poor R wave progression, and early repolarization changes, were associated with adverse clinical outcomes, including in-hospital mortality.
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Affiliation(s)
- P A O Alad
- University of the Philippines - Philippine General Hospital , Manila , Philippines
| | - F E R Punzalan
- University of the Philippines - Philippine General Hospital , Manila , Philippines
| | - E J B Llanes
- University of the Philippines - Philippine General Hospital , Manila , Philippines
| | - J A M Aherrera
- University of the Philippines - Philippine General Hospital , Manila , Philippines
| | - G G Gervacio
- University of the Philippines - Philippine General Hospital , Manila , Philippines
| | - E B Reyes
- University of the Philippines - Philippine General Hospital , Manila , Philippines
| | - J C Anonuevo
- University of the Philippines - Philippine General Hospital , Manila , Philippines
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Cowie MR, Mourilhe-Rocha R, Chang HY, Volterrani M, Ban HN, de Albuquerque DC, Chung E, Fonseca C, Lopatin Y, Serrano JAM, Mircheva L, Moncada-Paz GA, Pagava Z, Reyes EB, Saldarriaga C, Schwartzmann P, Leng DSK, Trivi M, Yotov YT, Zieroth S. The impact of the COVID-19 pandemic on heart failure management: Global experience of the OPTIMIZE heart failure care network. Int J Cardiol 2022; 363:240-246. [PMID: 35750302 PMCID: PMC9217066 DOI: 10.1016/j.ijcard.2022.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/18/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022]
Abstract
During the COVID-19 pandemic, reductions in heart failure (HF) hospitalizations have been widely reported, and there is an urgent need to understand how HF care has been reorganized in countries with different infection levels, vaccination rates and healthcare services. The OPTIMIZE Heart Failure Care program has a global network of investigators in 42 countries, with first-hand experience of the impact of the pandemic on HF management in different care settings. The national coordinators were surveyed to assess: 1) the challenges of the COVID-19 pandemic for continuity of HF care, from both a hospital and patient perspective; 2) the organizational changes enacted to ensure continued HF care; and 3) lessons learned for the future of HF care. Contributions were obtained from 37 national coordinators in 29 countries. We summarize their input, highlighting the issues raised and using the example of three very different settings (Italy, Brazil, and Taiwan) to illustrate the similarities and differences across the OPTIMIZE program.
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Affiliation(s)
- Martin R Cowie
- Royal Brompton Hospital, Guy's & St Thomas' NHS Foundation Trust, and School of Cardiovascular Medicine and Sciences, Faculty of Lifesciences & Medicine, King's College London, London, UK.
| | - Ricardo Mourilhe-Rocha
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Hung-Yu Chang
- Heart Center, Cheng Hsin General Hospital, and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Maurizio Volterrani
- Department of Cardiovascular and Respiratory Sciences, Scientific Institute for Research, Hospitalization and Health Care (IRCCS) San Raffaele Roma, Rome, Italy
| | - Ha Ngoc Ban
- Ho Chi Minh City Heart Institute, Ho Chi Minh City, Viet Nam
| | | | - Edward Chung
- Department of Medicine, University of the West Indies, Mona, Jamaica
| | - Cândida Fonseca
- Heart Failure Clinic, Department of Internal Medicine, São Francisco Xavier Hospital, and NOVA Medical School, Faculty of Medical Sciences, NOVA University, Lisbon, Portugal
| | - Yuri Lopatin
- Regional Cardiology Centre, Volgograd State Medical University, Volgograd, Russian Federation
| | - José Antonio Magaña Serrano
- Division of Heart Failure and Cardiac Transplantation, Cardiology Hospital, National Medical Center "Siglo XXI", Mexican Social Security Institute, Mexico City, Mexico
| | - Lilyana Mircheva
- Second Cardiology Clinic, University Hospital St. Marina, and First Department of Internal Medicine, Medical University of Varna, Varna, Bulgaria
| | - Gustavo Adolfo Moncada-Paz
- Department of Cardiology, Honduran Social Security Institute, and Faculty of Medical Sciences, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Zurab Pagava
- Bokhua Memorial Cardiovascular Center, Tbilisi, Georgia
| | - Eugenio B Reyes
- Philippine General Hospital and Division of Cardiovascular Medicine, University of the Philippines, Manila, Philippines
| | - Clara Saldarriaga
- Department of Cardiology, Pontifical Bolivarian University and University of Antioquia, Medellín, Colombia
| | - Pedro Schwartzmann
- Unimed Hospital Ribeirão Preto and Advanced Center for Research, Teaching and Diagnosis, Ribeirão Preto, SP, Brazil
| | | | - Marcelo Trivi
- Department of Clinical Cardiology, Buenos Aires Cardiovascular Institute, Buenos Aires, Argentina
| | - Yoto Trifonov Yotov
- Second Cardiology Clinic, University Hospital St. Marina, and First Department of Internal Medicine, Medical University of Varna, Varna, Bulgaria
| | - Shelley Zieroth
- Heart Failure and Transplant Clinics, St. Boniface Hospital, and Section of Cardiology, University of Manitoba, Winnipeg, MB, Canada
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Tan JWC, Sim D, Ako J, Almahmeed W, Cooper ME, Dalal JJ, Deerochanawong C, Huang DWC, Johar S, Kaul U, Kim SG, Koh N, Kong APS, Krittayaphong R, Kwok B, Matawaran BJ, Nguyen QN, Ong LM, Park JJ, Peng Y, Quek DK, Suastika K, Sukor N, Teo BW, Teoh CK, Zhang J, Reyes EB, Goh SY. Consensus Recommendations by the Asian Pacific Society of Cardiology: Optimising Cardiovascular Outcomes in Patients with Type 2 Diabetes. Eur Cardiol 2021; 16:e14. [PMID: 33976709 PMCID: PMC8086420 DOI: 10.15420/ecr.2020.52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/15/2021] [Indexed: 12/13/2022] Open
Abstract
The Asian Pacific Society of Cardiology convened a consensus statement panel for optimising cardiovascular (CV) outcomes in type 2 diabetes, and reviewed the current literature. Relevant articles were appraised using the Grading of Recommendations, Assessment, Development and Evaluation system, and consensus statements were developed in two meetings and were confirmed through online voting. The consensus statements indicated that lifestyle interventions must be emphasised for patients with prediabetes, and optimal glucose control should be encouraged when possible. Sodium–glucose cotransporter 2 inhibitors (SGLT2i) are recommended for patients with chronic kidney disease with adequate renal function, and for patients with heart failure with reduced ejection fraction. In addition to SGLT2i, glucagon-like peptide-1 receptor agonists are recommended for patients at high risk of CV events. A blood pressure target below 140/90 mmHg is generally recommended for patients with type 2 diabetes. Antiplatelet therapy is recommended for secondary prevention in patients with atherosclerotic CV disease.
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Affiliation(s)
| | | | - Junya Ako
- Kitasato University and Hospital Tokyo, Japan
| | | | | | | | | | - David Wei Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University Taipei, Taiwan.,Department of Physical Therapy, Fooyin University Kaohsiung, Taiwan
| | | | - Upendra Kaul
- Batra Hospital and Medical Research Centre New Delhi, India
| | - Sin Gon Kim
- Korea University College of Medicine Seoul, South Korea
| | | | | | | | | | | | - Quang Ngoc Nguyen
- Department of Cardiology, Vietnam National Heart Institute Hanoi Medical University, Hanoi, Vietnam
| | | | - Jin Joo Park
- Seoul National University Bundang Hospital Seongnam, South Korea
| | | | | | | | - Norlela Sukor
- Department of Medicine Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Boon Wee Teo
- Yong Loo Ling School of Medicine National University of Singapore, Singapore
| | | | - Jian Zhang
- Peking Union Medical College Beijing, China
| | - Eugenio B Reyes
- Division of Cardiovascular Medicine University of the Philippines, Philippine General Hospital, University of the Philippines Manila, Manila, the Philippines
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Chandramouli C, Teng THK, Tay WT, Yap J, MacDonald MR, Tromp J, Yan L, Siswanto B, Reyes EB, Ngarmukos T, Yu CM, Hung CL, Anand I, Richards AM, Ling LH, Regensteiner JG, Lam CSP. Impact of diabetes and sex in heart failure with reduced ejection fraction patients from the ASIAN-HF registry. Eur J Heart Fail 2018; 21:297-307. [PMID: 30548089 DOI: 10.1002/ejhf.1358] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/24/2018] [Accepted: 10/14/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS To examine sex differences in clinical characteristics, echocardiographic features, quality of life and 1-year death or heart failure (HF) hospitalization outcomes in patients with/without diabetes mellitus (DM). METHODS AND RESULTS Utilizing the Asian Sudden Cardiac Death in HF (ASIAN-HF) registry, 5255 patients (mean age 59.6 ± 13.1, 78% men) with symptomatic HF with reduced ejection fraction (HFrEF) were stratified by DM status to address the research aims. Despite similar prevalence of DM between Asian men (43%) and women (42%), the odds of DM increased at lower body mass index in women vs. men (≥ 23 vs. ≥ 27.5 kg/m2 , Pinteraction = 0.014). DM was more strongly related to chronic kidney disease in women vs. men [adjusted odds ratio (OR) 1.85, 95% confidence interval (CI) 1.33-2.57 vs. OR 1.32, 95% CI 1.11-1.56, Pinteraction = 0.009]. Sex also modified the relationship between DM and left ventricular geometry (Pinteraction = 0.003), whereby DM was associated with a more concentric left ventricular geometry in women than men. Women had lower quality of life than men (P < 0.001), in both DM and non-DM groups. DM was associated with worse composite outcomes at 1 year in women vs. men [hazard ratio (HR) 1.79, 95% CI 1.24-2.60 vs. HR 1.32, 95% CI 1.12-1.56; Pinteraction = 0.005). CONCLUSIONS Asian women with HFrEF were more likely to have DM despite a lean body mass index, a greater burden of chronic kidney disease and more concentric left ventricular geometry, compared to men. Furthermore, DM confers worse quality of life, irrespective of sex, and a greater risk of adverse outcomes in women than men. These data underscore the need for sex-specific approaches to diabetes in patients with HF.
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Affiliation(s)
| | | | | | | | | | - Jasper Tromp
- National Heart Centre Singapore, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Limin Yan
- National Heart Centre Singapore, Singapore
| | - Bambang Siswanto
- National Cardiovascular Center Universitas Indonesia, Jakarta, Indonesia
| | | | | | - Cheuk-Man Yu
- Hong Kong Baptist Hospital, The Chinese University of Hong Kong, Hong Kong, The People's Republic of China
| | | | - Inder Anand
- Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - A Mark Richards
- Cardiovascular Research Institute, Singapore.,National University of Singapore, Singapore.,Christchurch Heart Institute, University of Otago, Otago, New Zealand
| | | | | | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands.,Duke-National University of Singapore, Singapore
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Mentz RJ, Roessig L, Greenberg BH, Sato N, Shinagawa K, Yeo D, Kwok BWK, Reyes EB, Krum H, Pieske B, Greene SJ, Ambrosy AP, Kelly JP, Zannad F, Pitt B, Lam CSP. Heart Failure Clinical Trials in East and Southeast Asia: Understanding the Importance and Defining the Next Steps. JACC Heart Fail 2017; 4:419-27. [PMID: 27256745 DOI: 10.1016/j.jchf.2016.01.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 12/22/2015] [Accepted: 01/08/2016] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is a major and increasing global public health problem. In Asia, aging populations and recent increases in cardiovascular risk factors have contributed to a particularly high burden of HF, with outcomes that are poorer than those in the rest of the world. Representation of Asians in landmark HF trials has been variable. In addition, HF patients from Asia demonstrate clinical differences from patients in other geographic regions. Thus, the generalizability of some clinical trial results to the Asian population remains uncertain. In this article, we review differences in HF phenotype, HF management, and outcomes in patients from East and Southeast Asia. We describe lessons learned in Asia from recent HF registries and clinical trial databases and outline strategies to improve the potential for success in future trials. This review is based on discussions among scientists, clinical trialists, industry representatives, and regulatory representatives at the CardioVascular Clinical Trialist Asia Forum in Singapore on July 4, 2014.
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Affiliation(s)
- Robert J Mentz
- Duke Clinical Research Institute and the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
| | | | - Barry H Greenberg
- Division of Cardiology, University of California San Diego, San Diego, California
| | - Naoki Sato
- Internal Medicine, Cardiology, and Intensive Care Medicine, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Kaori Shinagawa
- Office of New Drug II, Pharmaceuticals and Medical Devices Agency, Chiyoda-ku, Tokyo, Japan
| | | | | | | | - Henry Krum
- Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Burkert Pieske
- Department of Cardiology, Charité University Medicine, Campus Virchow Klinikum, and German Heart Center Berlin, Berlin, Germany
| | - Stephen J Greene
- Duke Clinical Research Institute and the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Andrew P Ambrosy
- Duke Clinical Research Institute and the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Jacob P Kelly
- Duke Clinical Research Institute and the Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Faiez Zannad
- INSERM, Centre d'Investigations Cliniques-Plurithématique 1433, Vandoeuvre-lès-Nancy, France; INSERM U1116, Nancy, France; Université de Lorraine, Nancy, France; CHU Nancy, Pôle de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre-lès-Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
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Abarquez RF, Reganit PFM, Chungunco CN, Alcover J, Punzalan FER, Reyes EB, Cunanan EL. Chronic Heart Failure Clinical Practice Guidelines' Class 1-A Pharmacologic Recommendations: Start-to-End Synergistic Drug Therapy? ASEAN Heart J 2016; 24:4. [PMID: 27054142 PMCID: PMC4781891 DOI: 10.7603/s40602-016-0004-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic heart failure (HF) disease as an emerging epidemic has a high economic-psycho-social burden, hospitalization, readmission, morbidity and mortality rates despite many clinical practice guidelines' evidenced-based and consensus driven recommendations that include trials' initial-baseline data. OBJECTIVE To show that the survival and hospitalization-free event rates in the reviewed chronic HF clinical practice guidelines' class I-A recommendations as initial HF drug therapy (IDT) is possibly a combination and 'start-to-end' synergistic effect of the add-on ('end') HF drug therapy (ADT) to the baseline ('start') HF drug therapy (BDT). METHODOLOGY The references cited in the chronic HF clinical practice guidelines of the 2005, 2009, and 2013 American Heart Association/American College of Cardiology (AHA/ACC), the 2006 Heart Failure Society of America (HFSA), and the 2005, 2008, and 2012 European Society of Cardiology (ESC) were reviewed and compared with the respective guidelines' and other countries' recommendations. RESULTS The BDT using glycosides and diuretics is 79%-100% in the cited HF trials. The survival rates attributed to the BDT ('start') is 46%-89% and IDT ('end') 61%-92.8%, respectively. The hospitalization-free event rate of the BDT group: 47.1% to 85.3% and IDT group 61.8%-90%, respectively. Thus, the survival and hospitalization-free event rates of the ADT is 0.4%-15% and 4.6% to 14.7%, respectively. The extrapolated BDT survival is 8%-51% based on a 38% estimated natural HF survival rate for the time period109. CONCLUSION The contribution of baseline HF drug therapy (BDT) is relevant in terms of survival and hospitalization-free event rates compared to the HF class 1-A guidelines initial drug therapy recommendations (IDT). Further, the proposed initial HF drug ('end') therapy (IDT) has possible synergistic effects with the baseline HF drug ('start') therapy (BDT) and is essentially the add on HF drug therapy (ADT) in our analysis. The polypharmacy HF treatment is a synergistic effect due to BDT and ADT.
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Affiliation(s)
- Ramon F. Abarquez
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Paul Ferdinand M. Reganit
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Carmen N. Chungunco
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Jean Alcover
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Felix Eduardo R. Punzalan
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Eugenio B. Reyes
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
| | - Elleen L. Cunanan
- Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines
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Abstract
Hypertension incurs a significant healthcare burden in Asia-Pacific countries, which have suboptimal rates of blood pressure (BP) treatment and control. A consensus meeting of hypertension experts from the Asia-Pacific region convened in Hanoi, Vietnam, in April 2013. The principal objectives were to discuss the growing problem of hypertension in the Asia-Pacific region, and to develop consensus recommendations to promote standards of care across the region. A particular focus was recommendations for combination therapy, since it is known that most patients with hypertension will require two or more antihypertensive drugs to achieve BP control, and also that combinations of drugs with complementary mechanisms of action achieve BP targets more effectively than monotherapy. The expert panel reviewed guidelines for hypertension management from the USA and Europe, as well as individual Asia-Pacific countries, and devised a treatment matrix/guide, in which they propose the preferred combination therapy regimens for patients with hypertension, both with and without compelling indications. This report summarizes key recommendations from the group, including recommended antihypertensive combinations for specific patient populations. These strategies generally entail initiating therapy with free drug combinations, starting with the lowest available dosage, followed by treatment with single-pill combinations once the BP target has been achieved. A single reference for the whole Asia-Pacific region may contribute to increased consistency of treatment and greater proportions of patients achieving BP control, and hence reducing hypertension-related morbidity and mortality.
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Tomlinson B, Dalal JJ, Huang J, Low LP, Park CG, Rahman AR, Reyes EB, Soenarta AA, Heagerty A, Follath F. The role of β-blockers in the management of hypertension: an Asian perspective. Curr Med Res Opin 2011; 27:1021-33. [PMID: 21410302 DOI: 10.1185/03007995.2011.562884] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Following publication of the National Institute of Clinical Excellence (NICE) Guidelines in 2006, the use of β-blockers as first-line therapy in hypertension has been somewhat controversial. However, a recent reappraisal of the European Society of Hypertension guidelines highlights that these agents exhibit similar BP lowering efficacy to other classes of agents, prompting a re-examination of the utility of these agents in various patient populations. The authors felt that it is important to address this controversy and provide an Asian perspective on the place of β-blockers in current clinical practice and the benefits of β-blockade in selected patient populations. In addition to their use as a potential first-line therapy in uncomplicated hypertension, β-blockers have a particular role in patients with hypertension and comorbidities such as heart failure or coronary artery disease, including those who had a myocardial infarction. One advantage which β-blockers offer is the additional protective effects in patients with prior cardiovascular events. Some of the disadvantages attributed to β-blockers appear more related to the older drugs in this class and further appraisal of the efficacy and safety profile of newer β-blockers will lend support to the current guideline recommendations in Asian countries and encourage increased appropriate use of β-blockade in current clinical practice within Asia.
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Affiliation(s)
- B Tomlinson
- Department of Medicine and Therapeutics; Division of Clinical Pharmacology, The Chinese University of Hong Kong, Hong Kong SAR.
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