P-182: 24-hour ambulatory blood-pressure effects of valsartan + hydrochlorothiazide combinations compared with amlodipine in hypertensive patients at increased cardiovascular risk

In a randomised, double-blind trial, the effects on 24-hr ABP of the combination valsartan 160 mg od and hydrochlorothiazide (HCTZ) 25 or 12.5 mg during 24 weeks of therapy were compared with the effects of amlodipine 10 mg monotherapy (group A10) in 474 stage-II hypertensive patients with additional cardiovascular risk factors. After a two-week single-blind placebo run-in period, patients were randomised to receive valsartan 160 mg od or amlodipine 5 mg od. At Week 4, HCTZ 12.5 mg (group V160/HCTZ12.5) and 25 mg (group V160/HCTZ25) were added to the valsartan groups and in the A10 patients the amlodipine dose was force-titrated to 10 mg od. All treatments reduced BP as well as night-time and daytime BP levels from baseline. 24-hr SBP was reduced by 15.9 ±1.0 mmHg (least-squares mean change ±SE), 19.3 ±1.0 mmHg and 16.1 ±1.1 mmHg in the V160/HCTZ12.5, V160/HCTZ25 and A10 groups, respectively and 24-hr DBP was reduced by 9.3 ±0.6 mmHg, 11.4 ±0.6 mmHg and 9.6 ±0.7 mmHg in the three groups. The differences between the V160/HCTZ25 group and the A10 group were significant (p<0.05) for the changes in 24-hr systolic BP as well as for changes in daytime systolic BP and night-time diastolic BP. Control rates defined as ABPM ≤130/80 mmHg were: 48.4%, 60.8% and 50.9% in the V160/HCTZ12.5, V160/25 and A10 groups, respectively; the differences between the V160/HCTZ25 group and the other two treatment groups were significant at p<0.05. (See Figure) In conclusion, the fixed-dose combination of valsartan 160 mg + HCTZ 25 mg od is an attractive therapeutic option measured on the effects on 24-hr ABPM, night-time and daytime BP reduction and control rates in hypertensive patients at additional cardiovascular ris

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: A multi-centre study

The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40–50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses

Postoperative pain management in non-traumatic emergency general surgery : WSES-GAIS-SIAARTI-AAST guidelines

Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.Peer reviewe

Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines

Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies

Efficacy and safety of the direct renin inhibitor aliskiren and ramipril alone or in combination in patients with diabetes and hypertension

Objective. To assess the antihypertensive efficacy and safety of the combination of the direct renin inhibitor aliskiren and ramipril in patients with diabetes and hypertension

Factors predicting influence of body weight loss on blood pressure reduction in mild to borderline hypertensives

Wstęp: Celem pracy była ocena wpływu zmiany masy ciała, a także wyjściowego stężenia wartości katecholamin na wysokość ciśnienia tętniczego krwi (BP), mierzonego w warunkach przygodnych i ambulatoryjnych u pacjentów z granicznym i łagodnym nadciśnieniem tętniczym oraz z przeprowadzonym wywiadem rodzinnym, dotyczącym nadciśnienia tętniczego, zarówno potwierdzającym, jak i wykluczającym jego obecność. Metody: W populacji 744 osób z granicznym i łagodnym nadciśnieniem tętniczym, uczestniczących w wieloośrodkowym programie HARVEST, wykonano pomiary przygodne i ambulatoryjne BP oraz 24-godzinne wydalanie katecholamin z moczem. Następnie pacjentom polecono zmniejszyć kaloryczność posiłków. Po 3 miesiącach powtórzono ambulatoryjny pomiar ciśnienia tętniczego. Badani zostali podzieleni na dwie grupy: grupę I (z utratą masy ciała po 3 miesiącach obserwacji) i grupę II (bez spadku masy ciała) oraz w zależności od wywiadu, który wykluczał (FH+) lub potwierdzał (FH-) obecność nadciśnienia tętniczego w rodzinie. Wyniki: Po 3 miesiącach masa obniżyła się o 2,7 &plusmn; 0,1 kg w grupie I i wzrosła o 1,0 &plusmn; 0,1 kg w grupie II. W obrębie obu badanych grup pacjenci FH- i FH+ wykazali podobne zmiany masy ciała. BP mierzone w warunkach przygodnych obniżyło się w podobnym stopniu w obu grupach, podczas gdy BP mierzone ambulatoryjnie spadło jedynie w grupie I (SBP p < 0,003, DBP p < 0,001). W grupie I FH+ stwierdzono, że spadek masy ciała miał większy wpływ na 24-godzinne DBP niż w grupie I FH- (p < 0,04). Porównując obie grupy stwierdzono, że jedynie w grupie I FH+ wystąpił znaczący spadek SBP (p < 0,03) i DBP (p < 0,01) w porównaniu do grupy II. W dwustopniowej analizie ANCOVA wywiad rodzinny i poziom dopaminy w moczu negatywnie korelowały ze spadkiem BP zależnym od redukcji masy ciała (p < 0,05). Ponadto stwierdzono interakcję pomiędzy poziomem dopaminy, wywiadem rodzinnym a utratą masy ciała (p = 0,05). Wnioski: Podsumowując, wśród pacjentów z granicznym i łagodnym nadciśnieniem tętniczym wpływ redukcji masy ciała na wysokość BP jest skuteczny tylko u osób, u których w rodzinie stwierdzono obecność nadciśnienia tętniczego. Wykrycie niskich wartości dopaminy u tych chorych jest dodatkowym czynnikiem skłaniającym do zalecenia redukcji masy ciała.Background to investigate how changes in body weight (BW) af fect office and ambulatory blood pressure (BP) and are related to baseline catecholamines in hypertensives with positive (FH+) and negative (FH-) family history of hypertension. Methods in 744 borderline to mild hypertensives (535 men and 209 women) participating in the HARVEST study 24-h urine catecholamines, office and ambulatory BP (A&D TM2420 or Spacelabs 90207) were measured. Overweight patients were advised to decrease calorie intake. After 3 months ambulatory BP was repeated. Subjects were divided into two groups, according to whether their BW decreased (G1) or not (GZ) and by FH status (G1FH+, n=118; G1FH-, n=203; C=2FH+, n=178; G2FH-, n=245). Results After 3 months BW decreased by 2,7&plusmn;0.1 kg in Gl and increased by 1.0&plusmn;0.1 kg in G2. Within the two groups, FH+ and FH- subjects changed BW to a similar extent. Office BP fell to a similar extent in the two groups, while ambulatory BP showed a decrease only in Gl in comparison with G2 (systolic BP (SBP)=-1.8&plusmn;0.5 vs +0.3&plusmn;0.4 mmHg, p=0.003; diastolic BP (DBP)=-1.7&plusmn;0.4 vs 0.00.3 mmHg, p=0.001). G1FH+ subjects showed a greater response of 24-h BP fo BW loss than G1FH- (DBP=-2.5&plusmn;0.5 vs O.6&plusmn;0.6 mmHg, p=0.04; SBP=2.5&plusmn;0.7 vs -0.8&plusmn;0.8 mmHg, ns). In comparison with G2, only G1FH+ subjects showed a significant decrease in ambulatory SBP (p=0.03) and DBP (p=0.01). A negative correlation was observed between baseline urinary Dopamine and changes in 24-h BP in FH+ subjects (SBP r=-0.135, p=0.02; DBP r=-0.119, p=0.047) but not in FH- subjects. In either group no correlation was found between BP changes and Epinephrine or Norepinephrine. Conclusions in mild hypertensives weight reduction is effective mostiy in patients with FH+. Detection of low Dopamine values is an additional reason for recommending BW loss in these subjects