Implementation of ACE Inhibitor Regimen in Patients With Type 2 Diabetes Mellitus

The incidence of type 2 diabetes has increased dramatically and is associated with many problems, including chronic kidney disease. The purpose of this quality improvement project was to implement two evidence-based guidelines that may detect chronic kidney disease and slow its progression in patients with type 2 diabetes by implementing angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy according to evidence-based guidelines from the American Diabetes Association. Patients with type diabetes were screened for microalbuminuria and eGFR of \u3c 60 mL/min/1.73 m2. Based on lab results, the provider recommended either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to patients with as appropriate. The primary aim of this project was to achieve 80% implementation of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for patients with type 2 diabetes who met criteria. Second, seventy to 90 percent of early progression to chronic kidney disease among those with type 2 diabetes was to be identified via blood and urine testing. One hundred and sixty-three patients with type 2 diabetes were seen during the implementation phase and screened, and one hundred and thirty-two patients who needed an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker were placed on one or the other. Thirteen patients were on an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker prior to project implementation. Introducing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker as recommended for many patients with type 2 diabetes may slow the progression of chronic kidney disease and improve quality of life

ACE inhibitor‐associated intestinal angioedema in orthotopic heart transplantation

Angiotensin‐converting enzyme inhibitor induced angioedema commonly involves the head and neck area. We report a case of angiotensin‐converting enzyme inhibitor induced intestinal angioedema in a heart transplant recipient on mTOR immunosuppression. A 36‐year‐old Caucasian woman with history of heart transplantation on sirolimus, tacrolimus and prednisone presented to the Emergency Department with abdominal pain, one day following lisinopril initiation. A computer tomography scan demonstrated diffuse bowel wall thickening consistent with pancolitis and edema. She was subsequently diagnosed with angiotensin‐converting enzyme inhibitor induced angioedema. Patients on mTOR immunosuppression are at higher risk for this potentially life‐threatening side effect. Knowledge of this interaction is critical for providers prescribing mTOR agents.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138380/1/ehf212161.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138380/2/ehf212161_am.pd

Is there a difference between an angiotensin-converting enzyme inhibitor and an angiotensin-specific receptor blocker for the treatment of hypertension?

No Abstract. Keywords: angiotensin-converting enzyme inhibitor, ACE, angiotensin-specific receptor blocker, AR

Prescribing Patterns and Cost of Antihypertensive Drugs in Private Hospitals in Dar es Salaam, Tanzania

Antihypertensive agents are used to prevent morbidity and mortality related to hypertension. Prescribing patterns and the cost of some antihypertensive were studied for 600 patients attending medical clinics in four private hospitals in Dar es Salaam using the WHO drug use indicator forms. The average number of drugs per prescription ranged from 1.9 to 4.2 while that of antihypertensives varied from 1.3 to 2.1. About 50 % of the prescriptions contained 2 to 3 drugs. The most frequently prescribed antihypertensives were diuretics (41 %), β-blockers (28.5 %), calciumchannel blockers (19.8 %), hydralazine/losartan (18.5 %) and angiotensinconverting enzyme inhibitors (11.5 %). Antihypertensives prescribed asmonotherapy included atenolol (23.2 %), bendrofluazide (22 %), frusemide (19 %), hydralazine (11.2 %), nifedipine (9.8 %), amlodipine (9.5 %) and enalapril (9.3 %). Among the combination therapy drugs were angiotensin converting enzyme inhibitor+diuretic (7 %), β-blocker+diuretic (4 %), calcium channel blocker+losartan (2.3 %), β-blocker+angiotensin converting enzyme inhibitor (2.2 %), calcium channel blocker+angiotensin converting enzyme inhibitor (1.8 %) and diuretic+hydralazine (1.7 %). The cost of nifedipine, bendrofluazide and frusemide was about five to six times higher in the private hospitals than at the governmentowned medical stores department. This study reveals a need for continuingeducation and standard treatment guidelines for rational prescribing ofantihypertensive drugs

ANALISIS EFEKTIVITAS BIAYA PENGGUNAAN ANTIHIPERTENSI DUA KOMBINASI PADA PASIEN HIPERTENSI RAWAT JALAN DI RUMAH SAKIT ISLAM SURAKARTA TAHUN 2009

Terapi kombinasi yang tepat untuk mencegah terjadinya morbiditas dan mortalitas akibat tekanan darah tinggi sangat dibutuhkan pada penderita hipertensi tahap 2 sesuai tingkat keparahannya. Penelitian ini bertujuan membandingkan penggunaan kombinasi dua antihipertensi yang lebih cost effective pada pasien hipertensi rawat jalan di Rumah Sakit Islam Yarsis Surakarta tahun 2009. Penelitian ini bersifat deskriptif. Pengambilan data dilakukan secara retrospektif berdasarkan rekam medik. Kriteria inklusi yaitu pasien hipertensi rawat jalan dengan usia lebih dari 18 tahun yang menggunakan kombinasi dua antihipertensi oral yang sama minimal selama dua bulan berturut-turut. Analisis biaya yang dihitung biaya medik langsung (sudut pandang rumah sakit) meliputi biaya antihipertensi oral, biaya pendaftaran, biaya periksa dan total biaya terapi. Analisis efektivitas biaya dilakukan dengan membandingkan besar biaya medik langsung rata-rata per bulan terhadap persentase pasien yang tekanan darahnya mencapai target. Hasil penelitian menunjukkan empat kelompok terapi dua kombinasi antihipertensi terbesar yang digunakan di RSI Yarsis antara lain kelompok terapi calsium channel blocker dan diuretik, angiotensin II receptor blocker dan diuretik, calsium channel blocker dan angiotensin converting enzyme inhibitor, serta kombinasi angiotensin converting enzyme inhibitor dan diuretik. Kelompok terapi kombinasi yang paling banyak digunakan adalah angiotensin converting enzyme inhibitor dan diuretik. Kelompok terapi kombinasi yang paling cost- effective adalah kelompok terapi angiotensin converting enzyme inhibitor dan diuretik

Icatibant is not an appropriate treatment option for ACE-inhibitor induced angioedema of the head and neck

A critical appraisal and clinical application of Sinert T, Levy P, Bernstein JA, et al. Randomized trial of icatibant for angiotensin-converting enzyme inhibitor-induced upper airway angioedema. J Allergy Clin Immunol Pract. 2017;5(5):1402-9. doi: 10.1016/j.jaip.2017.03.00

Icatibant is not helpful for the treatment of ACE inhibitor-induced angioedema

A critical appraisal and clinical application of Sinert R, Levy P, Bernstein JA, et al. Randomized trial of icatibant for angiotensin-converting enzyme inhibitor-induced upper airway angioedema. J Allergy Clin Immunol Pract. 2017; 5(5): 1402-1409. doi: 10.1016/j.jaip.2017.03.003

Supplementary data for “Comparisons of Staphylococcus aureus infection and other outcomes between users of angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers: lessons for COVID-19 from a nationwide cohort study”

Additional information regarding study design, baseline cohort characteristics, and results of sensitivity analyses

Left Ventricular Dysfunction in Patients Receiving Cardiotoxic Cancer Therapies Are Clinicians Responding Optimally?

ObjectivesThe purpose of this study was to examine treatment practices for cancer therapy-associated decreased left ventricular ejection fraction (LVEF) detected on echocardiography and whether management was consistent with American College of Cardiology/American Heart Association guidelines.BackgroundPatients treated with anthracyclines or trastuzumab are at risk of cardiotoxicity. Decreased LVEF represents a Class I indication for drug intervention according to American College of Cardiology/American Heart Association guidelines.MethodsPatients receiving anthracycline or trastuzumab at Stanford University from October 2005 to October 2007 and who had undergone echocardiography before and after receiving an anthracycline or trastuzumab were identified. Chart review examined chemotherapy regimens, cardiac risk factors, imaging results, concomitant medications, and cardiology consultations.ResultsEighty-eight patients received therapy with an anthracycline or trastuzumab and had a pre-treatment and follow-up echocardiogram. Ninety-two percent were treated with anthracyclines, 17% with trastuzumab after an anthracycline, and 8% with trastuzumab without previous treatment with anthracycline. Mean baseline LVEF was 60%, with 14% having a baseline <55%. Forty percent had decreased LVEF (<55%) after anthracycline and/or trastuzumab treatment. Of these patients, 40% received angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, 51% beta-blocker therapy, and 54% cardiology consultation. Of patients with asymptomatic decreased LVEF, 31% received angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, 35% beta-blocker therapy, and 42% cardiology consultation. Of those with symptomatic decreased LVEF, 67% received angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, 100% beta-blocker therapy, and 89% cardiology consultation.ConclusionsMany cancer survivors are not receiving treatment consistent with heart failure guidelines. There is substantial opportunity for collaboration between oncologists and cardiologists to improve the care of oncology patients receiving cardiotoxic therapy

Comparative effectiveness of enalapril, lisinopril, and ramipril in the treatment of patients with chronic heart failure: a propensity score-matched cohort study

Background: Angiotensin converting enzyme inhibitors (ACEIs) are recommended as first-line therapy in patients with heart failure with reduced ejection fraction (HFrEF). The comparative effectiveness of different ACEIs is not known. Methods and results: 4,723 out-patients with stable HFrEF prescribed either enalapril, lisinopril, or ramipril were identified from three registries in Norway, England, and Germany. In three separate matching procedures, patients were individually matched with respect to both dose equivalents and their respective propensity scores for ACEI treatment. During a follow-up of 21,939 patient-years, 360 (49.5%), 337 (52.4%), and 1,119 (33.4%) patients died amongst those prescribed enalapril, lisinopril, and ramipril, respectively. In univariable analysis of the general sample, enalapril and lisinopril were both associated with higher mortality as compared with ramipril treatment (HR 1.46, 95% CI 1.30-1.65, p &lt; 0.001, and HR 1.38, CI 1.22-1.56, p &lt; 0.001, respectively). Patients prescribed enalapril or lisinopril had similar mortality (HR 1.06, 95% CI 0.92-1.24, p = 0.41). However, there was no significant association between ACEI choice and all-cause mortality in any of the matched samples (HR 1.07, 95% CI 0.91-1.25, p = 0.40; HR 1.12, 95% CI 0.96-1.32, p = 0.16; and HR 1.08, HR 1.10, 95% CI 0.93-1.31, p = 0.25 for enalapril vs. ramipril, lisinopril vs. ramipril, and enalapril vs. lisinopril, respectively). Results were confirmed in subgroup analyses with respect to age, sex, left ventricular ejection fraction, NYHA functional class, cause of HFrEF, rhythm, and systolic blood pressure. Conclusion: Our results suggest that enalapril, lisinopril and ramipril are equally effective in the treatment of patients with HFrEF when given at equivalent doses