Electrolytes in early primary hypertension : an epidemiological approach

The studies presented in this thesis were conducted in a population of young, non-hospitalized subjects. This opportunity was presented by the availability of a large cohort of children and young adults that had been followed up for more than seven years as part of the Epidemiologic Preventive Organization zoetermeer {EPOZ study), and of which a large body of data on blood pressure and other characteristics could be used. The basic theme of the studies was to elucidate mechanisms involved hypertension, with special electrolytes. (chapter 1) in the early pa~hogenesis emphasis on the role of of primary dietary The effect of changes in electrolyte intake in youngsters elevated blood pressure was studied in two randomized trials. with The scientific concept in evaluating the of the randomized trial is of primary importance effect of a certain characteristic, like electrolyte intake, on another characteristic, like blood Randomization garantuees internal validity of a study with pressure. regard to potential sources of bias. In addition, blinding of participants and investigators for the type of intervention during the trial reduces the possibility of distortion of the results by information bias. Randomization may be accomplished by random assignment of individuals to a certain treatment, the parallel-group design, or by randomization of treatment periods within an individual, the crossover design. Both methods were applied in studies presented in this thesis. (chapter 2

Moving from research to practice: relevance and generalizability

Epidemiology is occurrence research. The object of epidemiologic research is the occurrence of illness and its relation to determinants (occurrence relation). Similar to other epidemiologic research, the motive for applied clinical studies is to learn about an object. Eventually, the knowledge produced by the research needs to be incorporated in the knowledge base that guides daily medical care. During the design and conduct of research, it is important to keep this aim in mind and be aware of the effects that choices in the design of the study may have on the applicability and implementation of the results

The polypill approach - An innovative strategy to improve cardiovascular health in Europe

Background: Cardiovascular disease (CVD) is a major cause of disability and premature death. Despite European guidelines advocating the use of medical therapies in CVD, many patients still do not achieve the guideline-recommended treatment, which highlights the need for change and innovations in this field. This requirement has been widely recognised by the national ministries of health, several European cardiology societies, and the European Parliament, who support the initiation of strategies to improve and promote cardiovascular health. Discussion: One of the key risk factors to recurrent cardiovascular events is the lack of adherence to medication and this has been added to the agenda of the European Commission. With the intention to improve treatment adherence in CVD, polypills have been investigated and numerous studies demonstrate that they significantly improve medication adherence, which contributes to the improvement of health outcomes. In Europe, the first cardiovascular polypill, developed by a public-private partnership (CNIC-Ferrer), recently became available for general prescription as a therapy for CVD prevention. This polypill significantly improves adherence, preventing fatal and non-fatal cardiovascular events, and appears to be a cost-effective strategy to improve sustainability of the health care systems in CVD. Conclusions: Given the importance of urgent and simple solutions to restraining the pandemic nature of CVD, the polypill approach should therefore be considered by physicians and public health systems as an available and innovative option to improve cardiovascular health.Financial support for the creation of this paper was provided by Ferrer Internacional. All content and opinions expressed in the article reflect those of the authors and were not influenced by Ferrer.S

Drug-induced heart failure

AbstractHeart failure is a clinical syndrome that is predominantly caused by cardiovascular disorders such as coronary heart disease and hypertension. However, several classes of drugs may induce heart failure in patients without concurrent cardiovascular disease or may precipitate the occurrence of heart failure in patients with preexisting left ventricular impairment. We reviewed the literature on drug-induced heart failure, using the MEDLINE database and lateral references. Successively, we discuss the potential role in the occurrence of heart failure of cytostatics, immunomodulating drugs, antidepressants, calcium channel blocking agents, nonsteroidal anti-inflammatory drugs, antiarrhythmics, beta-adrenoceptor blocking agents, anesthetics and some miscellaneous agents. Drug-induced heart failure may play a role in only a minority of the patients presenting with heart failure. Nevertheless, drug-induced heart failure should be regarded as a potentially preventable cause of heart failure, although sometimes other priorities do not offer therapeutic alternatives (e.g., anthracycline-induced cardiomyopathy). The awareness of clinicians of potential adverse effects on cardiac performance by several classes of drugs, particularly in patients with preexisting ventricular dysfunction, may contribute to timely diagnosis and prevention of drug-induced heart failure

Implementing Fixed Dose Combination Medications for the Prevention and Control of Cardiovascular Diseases.

Highlights:  - Despite clinical evidence of its effectiveness in secondary prevention of cardiovascular disease, uptake of fixed dose combination therapy (FDCs) for CVD has been poor.- A symposium was held bringing together stakeholders on this issue, including from academia, government and NGOs.- The conclusion made was that what is now needed to improve implementation of FDCs is country-specific health systems analyses to design appropriate implementation strategies.- Implementation strategies must look beyond listing on the WHO Essential Medicines List to consider approaches to improving FDC availability, accessibility, affordability, and adherence.- Strategies might include incorporation of FDCs into the WHO HEARTS technical package, simplified treatment and monitoring algorithms, decentralisation of medicine dispensing and task-sharing for treatment management