32 research outputs found
Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy
Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme
Combined antihypertensive medications
Arterial hypertension (AH) is one of the most prevalent diseases. Despite impressive progress in studying AH pathogenesis, treatment results should still be improved. It is mostly explained by poor therapy compliance in patients taking antihypertensive agents (AHA). At present, combined treatment is a priority in AH management. Fixed‑dose AHA combination use is a promising approach. The authors analyze the studies on effectiveness of combined AHA, most prevalent in Russia
Microcirculation in arterial hypertension patients receiving beta-adrenoblockers
Aim. To compare microcirculation (MC) functional status during the treatment with beta-adrenoblockers (BAB), with and without vasodilatatory effects, in patients with Stage I-II arterial hypertension (AH). Material and methods. In total, 61 Stage I-II patients and 30 relatively healthy volunteers were examined. AH patients received nebivolol or metoprolol for 24 weeks. At baseline, and after 4, 12, and 24 weeks, MC hemodynamic types (MCHT) were assessed by laser Doppler flowmetry (LAKK-02 device, “LASMA”, Russia). Ключевые слова: артериальная гипертония, состояние микроциркуляции, гемодинамические типы микроциркуляции, β-адреноблокаторы, небиволол, метопролол. Results. AH is characterized by heterogeneous MC changes: hyperemic MCHT is typical for Stage I AH, and stasis-congestive or spastic MCHT – for Stage II AH. During metoprolol therapy, normocirculatory MCHT increased, and hyperemic MCHT decreased. Nebivolol demonstrated normalizing effects, manifesting in decreased hyperemic or spastic MCHT and increased normocirculatory MCHT. Conclusion. Metoprolol improved MC functional status. Nebivolol normalized functional and morphological MC status