Fixed combination of irbesartan and hydrochlorothiazide in the management of hypertension

Approximately 25% of the adult population worldwide is hypertensive and thus at risk of cardiovascular morbidity and mortality. Despite the availability of many antihypertensive drugs, at least 50% of patients do not achieve blood pressure (BP) targets and thus remain at increased cardiovascular risk. Fixed-dose (FD) irbesartan/hydrochlorothiazide (HCTZ) is an antihypertensive combination therapy approved for the treatment of patients whose BP is not adequately controlled on monotherapy and for initial treatment of patients likely to need multiple drugs to achieve their BP goal. The efficacy and tolerability of FD irbesartan/HCTZ has been demonstrated in both patient populations in large multicenter studies. In patients failing antihypertensive monotherapy, FD irbesartan/HCTZ (150/12.5 mg) has been shown to be more effective than FD valsartan/HCTZ (80/12.5 mg) and at least comparable to FD losartan/HCTZ (50/12.5 mg). In patients with moderate or severe hypertension receiving FD irbesartan/HCTZ as initial therapy, this combination achieved more rapid BP reductions compared with irbesartan monotherapy and enabled a greater proportion of patients with severe hypertension to achieve their BP target. FD irbesartan/HCTZ is thus a valuable addition to the clinician’s armamentarium for the management of hypertension and should help more patients achieve their BP target

Teachers\u27 perceptions of professional development and pedagogical practice: a study of a Kentucky suburban school district.

Professional development supports teacher growth and enhances pedagogical practice. Teachers in Kentucky must complete annual professional development hours and districts must develop a professional development plan tied to research that supports high-quality professional development. This qualitative case study takes place in a rural district, Bullitt County, where I investigated the teachers’ perception of a customized professional development, Thinking Focus Cohort (TFC), and its impact on their pedagogical practice. While a body of research exists on high quality professional development, there is a lack of research on the effectiveness of it, in particular a year-long cohort model with curriculum centered around four pillars: learning of community, thinking strategies, gradual release of responsibility, and academic discourse. This study drew upon data collected from document analysis, semi-structured interviews and group level assessment (GLA). Document analysis provided an understanding of materials used throughout TFC and feedback gathered from outside observers and participants. The semi-structured interviews provided insight into participants’ perspectives on their experience of TCF. GLA questions functioned to fill the gap of information which addressed teachers’ perceptions of the Thinking Focus Cohort and its influence on teachers’ pedagogical practice, specifically focusing on the participants’ experience as a community of learners as well as their intentional pedagogical practices. Findings show the customized professional development, TFC, impacted teachers’ pedagogical practice from their perspective after reviewing the participants’ responses aligned with the selective codes. First, participants were able to identify intentional pedagogical practices they implemented, which also created higher teacher and student efficacy. Next, participants revealed the importance of instructional coaches serving as mentors to foster the perceived pedagogical changes. Finally, participants discussed how the teacher rounds provided exemplar modeling of the intended instructional strategies and created an avenue for collaboration throughout the district. In summary, the transformational changes to teachers’ pedagogical practice was supported through a year-long cohort of modeling instructional strategies tied to the curriculum while meeting monthly was enhanced through instructional coaches and teacher rounds. The demands of teaching have evolved -in part due to high stakes accountability systems. This is coupled with the hemorrhage of teachers leaving the profession for more personal and professional reasons. Professional development is a means for teachers to experience critical support through collaboration, thus resulting in pedagogical changes. The effective professional development and the desired results point directly to implications for policy and practice to mitigate compliance driven by regulations and law, suggesting instead the creation of structures to evaluate the effectiveness of professional development. This also points directly to examining the style of delivery and methods of support within the evaluation system of professional development. Teachers become models of continued learning focusing on improving their pedagogical practice. This study reveals the importance of high-quality professional development as a means to positively impact a teacher’s pedagogical practice

Gender differences in aortic valve replacement: is surgical aortic valve replacement riskier and transcatheter aortic valve replacement safer in women than in men?

Aortic stenosis (AS) is a progressive and degenerative disease that necessitates valve replacement through either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Various studies have shown that, unlike for TAVR, SAVR is associated with an elevated risk for women as compared to men. The aim of this review is to better understand the risks and their possible causes, associated with the use of both TAVR and SAVR in female patients. Our systematic review included studies published between 2012 and 2020, identified through specific searches of PubMed. Compatibility of publications, determined by the use of pre-defined inclusion/exclusion criteria, resulted in 15 articles being used in our review. Overall, more men than women undergo SAVR, but our findings confirmed that SAVR is associated with worse outcomes in women in the short-term. Reasons for a higher 30-day mortality post-SAVR in women include an increased age, higher in-hospital mortality and, possibly baseline comorbidities and anatomical differences. There was no difference observed in 30-day mortality between men and women undergoing TAVR. Female patients appear to have a better longer-term survival post-TAVR than their male counterparts. Understanding the reasons why women have worse outcomes post-SAVR is essential for ensuring appropriate treatment selection for patients with AS, as well as for achieving the best possible long-term and safety outcomes for these patients

Treatment of peripheral arterial disease using stem and progenitor cell therapy

Peripheral arterial disease (PAD) is a highly prevalent atherosclerotic syndrome associated with significant morbidity and mortality. PAD is most commonly caused by atherosclerosis obliterans (ASO) and thromboangiitis obliterans (TAO), and can lead to claudication and critical limb ischemia (CLI), often resulting in a need for major amputation and subsequent death. Standard treatment for such severe cases of PAD is surgical or endovascular revascularization. However, up to 30% of patients are not candidates for such interventions, due to high operative risk or unfavorable vascular involvement. Therefore, new strategies are needed to offer these patients a viable therapeutic option. Bone-marrow derived stem and progenitor cells have been identified as a potential new therapeutic option to induce angiogenesis. These findings prompted clinical researchers to explore the feasibility of cell therapies in patients with peripheral and coronary artery disease in several small trials. Clinical benefits were reported from these trials including improvement of ankle-brachial index (ABI), transcutaneous partial pressure of oxygen (TcO2), reduction of pain, and decreased need for amputation. Nonetheless, large randomized, placebo-controlled, double-blind studies are necessary and currently ongoing to provide stronger safety and efficacy data on cell therapy. Current literature is supportive of intramuscular bone marrow cell administration as a relatively safe, feasible, and possibly effective therapy for patients with PAD who are not subjects for conventional revascularization.Clinical RelevanceThis article describes the background and first results of stem and progenitor cell therapy in patients with critical limb ischemia not suitable for revascularization. The principle as far as it is understood and the methods are described. Compelling evidence suggests that progenitor cell therapy might become a useful adjunct to the treatment options at present. Due to poor prognosis and the increasing number of patients, there is a need for new therapeutic methods. The article gives an overview of first encouraging results provided by early-phase clinical trials. Challenges in this new therapeutic option still include open questions such as cell phenotype, processing, dosing, route of optimal delivery, and frequency of application. Validation by more rigorous controlled trials involving homogenous patient populations are required to confirm the first hopeful results

Office and ambulatory blood pressure control with a fixed-dose combination of candesartan and hydrochlorothiazide in previously uncontrolled hypertensive patients: results of CHILI CU Soon

Thomas Mengden1, Reinhold Hübner2, Peter Bramlage31Kerckhoff-Klinik GmbH, Bad Nauheim, 2Takeda Pharma GmbH, Aachen, 3Institut für Kardiovaskuläre Pharmakologie und Epidemiologie, Mahlow, GermanyBackground: Fixed-dose combinations of candesartan 32 mg and hydrochlorothiazide (HCTZ) have been shown to be effective in clinical trials. Upon market entry we conducted a noninterventional study to document the safety and effectiveness of this fixed-dose combination in an unselected population in primary care and to compare blood pressure (BP) values obtained during office measurement (OBPM) with ambulatory blood pressure measurement (ABPM).Methods: CHILI CU Soon was a prospective, noninterventional, noncontrolled, open-label, multicenter study with a follow-up of at least 10 weeks. High-risk patients aged ≥18 years with previously uncontrolled hypertension were started on candesartan 32 mg in a fixed-dose combination with either 12.5 mg or 25 mg HCTZ. OBPM and ABPM reduction and adverse events were documented.Results: A total of 4131 patients (52.8% male) with a mean age of 63.0 ± 11.0 years were included. BP was 162.1 ± 14.8/94.7 ± 9.2 mmHg during office visits at baseline. After 10 weeks of candesartan 32 mg/12.5 mg or 25 mg HCTZ, mean BP had lowered to 131.7 ± 10.5/80.0 ± 6.6 mmHg (P < 0.0001 for both comparisons). BP reduction was comparable irrespective of prior or concomitant medication. In patients for whom physicians regarded an ABPM to be necessary (because of suspected noncontrol over 24 hours), ABP at baseline was 158.2/93.7 mmHg during the day and 141.8/85.2 mmHg during the night. At the last visit, BP had significantly reduced to 133.6/80.0 mmHg and 121.0/72.3 mmHg, respectively, resulting in 20.8% being normotensive over 24 hours (<130/80 mmHg). The correlation between OBPM and ABPM was good (r = 0.589 for systolic BP and r = 0.389 for diastolic BP during the day). Of those who were normotensive upon OBPM, 35.1% had high ABPM during the day, 49.3% were nondippers, and 3.4% were inverted dippers. Forty-nine adverse events (1.19%) were reported, of which seven (0.17%) were regarded as serious.Conclusion: Candesartan 32 mg in a fixed-dose combination with either 12.5 mg or 25 mg HCTZ is safe and effective for further BP lowering irrespective of prior antihypertensive drug class not being able to control BP.Keywords: ambulatory blood pressure, office blood pressure, normalization, respons