Carvedilol in hypertension treatment

Although β-blockers have been previously shown to effectively reduce blood pressure (BP) and have been used for hypertension treatment for over 40 years, their effect on cardiovascular morbidity and mortality in hypertensive patients remains controversial and its use in uncomplicated hypertension is currently under debate. However, data on the above field derive mainly from studies which were conducted with older agents, such as atenolol and metoprolol, while considerable pharamacokinetic and pharmacodynamic heterogeneity is present within the class of β-blockers. Carvedilol, a vasodilating non-cardioselective β-blocker, is a compound that seems to give the opportunity to the clinician to use a cardioprotective agent without the concerning hemodynamic and metabolic actions of traditional β-blocker therapy. In contrast with conventional β-blockers, carvedilol maintains cardiac output, has a less extended effect on heart rate and reduces BP by decreasing vascular resistance. Further, several studies has shown that carvedilol has a beneficial or at least neutral effect on metabolic parameters, such as glycemic control, insulin sensitivity, and lipid metabolism, suggesting that they could be used in subjects with the metabolic syndrome or diabetes without negative consequences. This article summarizes the distinct pharmacologic, hemodynamic, and metabolic properties of carvedilol in relation to conventional β-blockers, attempting to examine the potential use of this agent for hypertension treatment

Physicians’ Perceptions and Adherence to Guidelines for the Management of Hypertension: A National, Multicentre, Prospective Study

Background. The aim of the current study was to investigate physicians’ perceptions and adherence to the European guidelines for the management of hypertension. Methods. This is a national, multicentre, prospective, observational study, conducted between November 2007 and June 2008, in Cyprus. Consecutive hypertensive patients have been recruited by a random sample of physicians. The physicians’ recommendations for every single patient have been recorded and compared with the 2007 ESH/ESC guidelines. Results. Of the total of 654 patients, 477 (72.9%) were correctly advised by their physician to receive antihypertensive treatment to control their blood pressure, while 396 (60.5%) correctly got advices to adopt only lifestyle changes. The overall adherence of physicians to the European guidelines (overall agreement rate) was 70.4% (k=0.258, P<0.001). Of the total of 68 physicians, 65 (95.6%) reported that they were aware of some guidelines. There was no statistically significant effect of specific physicians’ characteristics on the overall adherence to guidelines, but there was in the percentage of patients achieving medication guidelines. Conclusions. The study demonstrated that although Cypriot physicians declared that they were aware of the clinical guidelines for the management of hypertension, more than one-fourth of high risk hypertensive patients remained untreated and 40% of low risk patients received inappropriate medication

Telemonitoring in Chronic Heart Failure: A Systematic Review

Heart failure (HF) is a growing epidemic with the annual number of hospitalizations constantly increasing over the last decades for HF as a primary or secondary diagnosis. Despite the emergence of novel therapeutic approached that can prolong life and shorten hospital stay, HF patients will be needing rehospitalization and will often have a poor prognosis. Telemonitoring is a novel diagnostic modality that has been suggested to be beneficial for HF patients. Telemonitoring is viewed as a means of recording physiological data, such as body weight, heart rate, arterial blood pressure, and electrocardiogram recordings, by portable devices and transmitting these data remotely (via a telephone line, a mobile phone or a computer) to a server where they can be stored, reviewed and analyzed by the research team. In this systematic review of all randomized clinical trials evaluating telemonitoring in chronic HF, we aim to assess whether telemonitoring provides any substantial benefit in this patient population

A smart digital health platform to enable monitoring of quality of life and frailty in older patients with cancer: a mixed-methods, feasibility study protocol

Objectives: LifeChamps is an EU Horizon 2020 project that aims to create a digital platform to enable monitoring of health-related quality of life and frailty in patients with cancer over the age of 65. Our primary objective is to assess feasibility, usability, acceptability, fidelity, adherence, and safety parameters when implementing LifeChamps in routine cancer care. Secondary objectives involve evaluating preliminary signals of efficacy and cost-effectiveness indicators. Data Sources: This will be a mixed-methods exploratory project, involving four study sites in Greece, Spain, Sweden, and the United Kingdom. The quantitative component of LifeChamps (single-group, pre-post feasibility study) will integrate digital technologies, home-based motion sensors, self-administered questionnaires, and the electronic health record to (1) enable multimodal, real-world data collection, (2) provide patients with a coaching mobile app interface, and (3) equip healthcare professionals with an interactive, patient-monitoring dashboard. The qualitative component will determine end-user usability and acceptability via end-of-study surveys and interviews. Conclusion: The first patient was enrolled in the study in January 2023. Recruitment will be ongoing until the project finishes before the end of 2023. Implications for Nursing Practice: LifeChamps provides a comprehensive digital health platform to enable continuous monitoring of frailty indicators and health-related quality of life determinants in geriatric cancer care. Real-world data collection will generate “big data” sets to enable development of predictive algorithms to enable patient risk classification, identification of patients in need for a comprehensive geriatric assessment, and subsequently personalized care

The effect of alcohol consumption on blood pressure, novel cardiovascular risk factors and plasma oxidative activity in employees

Alcohol overconsumption is related with increased morbidity and mortality from more than 60 different diseases, whereas light alcohol consumption results remain contradictory, with a significant amount of studies even shown a decrease in cardiovascular morbidity and mortality. The aim of the present thesis is to investigate the effect of alcohol consumption on blood pressure and endothelial dysfunction markers, and in parallel to examine the presence of cardiovascular risk factors in a, theoretically, low risk working population, a fact that has not been extensively investigated so far. A cross-sectional study was carried out. We examined 512 employees (67% male) aged 42.13±8.49 (range 18 – 65) years. Approximately half of them were active smokers and one fifth of them obese. The prevalence of hypertensions was 34.9% and 22.4%, of diabetes mellitus 4.7% and 2.5% and of metabolic syndrome 41.1% and 33.7% for male and female respectively. Only 11 male (3.2%) and 26 female (15.6%) answered that during the last 12 months had not consumed alcohol (abstainers). Mean daily alcohol consumption in glasses per day was found to be 1.6 for male and 0.33 for female (p0.05). Finally, blood pressure increase in male seems to be significant only when they consume more than 2 glasses of alcohol daily (p0.05) compared to those who reported alcohol consumption. Nevertheless, Pearson correlation test has not confirmed the relationship between mean daily alcohol consumption and adhesion molecules ICAM-1 and VCAM-1 (-0.10.1). In the present study, chronic alcohol consumption did not seem to affect the markers of oxidative stress examined (p>0.05 for all comparisons). Oxidized LDL (oxLDL), serum oxidative stress markers (Oxystat) and prooxidant-antioxidant balance (PAB) were also not significantly altered in the various categories of alcohol consumption. In conclusion, alcohol consumption raises blood pressure in male but not in female. This increase becomes significant when alcohol consumption exceeds two glasses daily. The effect of alcohol on adhesion molecules and oxidative stress markers investigated was not significant, with the exception of higher ICAM-1 levels in abstainers compared to the rest of the subjects. These results probably show that chronic and rational alcohol consumption does not affect these processes remarkably. Consequently, the reduction of cardiovascular morbidity as a result of light alcohol consumption could be due to other pathophysiologic mechanisms.Η υπερκατανάλωση αλκοολούχων σκευασμάτων σχετίζεται με αυξημένη νοσηρότητα και θνησιμότητα από περισσότερα από 60 διαφορετικά νοσήματα, ενώ τα αποτελέσματα της ήπιας κατανάλωσης παραμένουν αμφιλεγόμενα, με ένα μεγάλο αριθμό μελετών να υποστηρίζει ότι μειώνει την καρδιαγγειακή νοσηρότητα και θνησιμότητα. Σκοπός της παρούσας διδακτορικής διατριβής είναι να διερευνήσει την επίδραση του αλκοόλ στην αρτηριακή πίεση και σε δείκτες ενδοθηλιακής δυσλειτουργίας και παράλληλα να ελέγξει την παρουσία παραγόντων καρδιαγγειακού κινδύνου σε ένα, θεωρητικά, χαμηλού κινδύνου πληθυσμό εργαζομένων, που σε ελάχιστες μελέτες έχει διερευνηθεί. Για το σκοπό αυτό διενεργήθηκε μελέτη εγκάρσιας τομής κατά την οποία εξετάστηκαν 512 εργαζόμενοι (67% άνδρες) με μέση ηλικία 42,13±8,49 έτη (εύρος 18 με 65 έτη). Οι μισοί σχεδόν εργαζόμενοι ήταν καπνιστές και το ένα πέμπτο παχύσαρκοι. Ο επιπολασμός της αρτηριακής υπέρτασης ήταν 34,9% και 22,4%, του σακχαρώδη διαβήτη 4,7% και 2,5% και του μεταβολικού συνδρόμου 41,1% και 33,7% για άνδρες και γυναίκες αντίστοιχα. Από το σύνολο των εργαζομένων, μόλις 11 άνδρες (3,2%) και 26 γυναίκες (15,6%) απάντησαν ότι τους τελευταίους 12 μήνες δεν κατανάλωσαν κανένα αλκοολούχο σκεύασμα (abstainers). Η μέση ημερήσια κατανάλωση αλκοολούχων σκευασμάτων σε ποτήρια ανά ημέρα ήταν 1,6 για τους άνδρες και 0,33 για τις γυναίκες (p0,05). Τέλος, η αύξηση της ΑΠ στους άνδρες φαίνεται να είναι σημαντική μόνο όταν αυτοί καταναλώνουν περισσότερα από 2 ποτήρια αλκοόλ ημερησίως. Οι εργαζόμενοι που δεν πίνουν καθόλου αλκοόλ είχαν σημαντικά υψηλότερες τιμές ICAM-1 (άνδρες 910,50±302,45 ng/ml vs 709,17±308,72 ng/ml, p=0,034, γυναίκες 882,06±410,50 ng/ml vs 696,18±300,69 ng/ml, p=0,008), αλλά όχι VCAM-1 (p>0,05) από τους εργαζόμενους που καταναλώνουν αλκοόλ. Παρόλα αυτά, η δοκιμασία Pearson δεν επιβεβαίωσε τη συσχέτιση μεταξύ της μέσης ημερήσιας κατανάλωσης αλκοόλ και των μορίων προσκόλλησης ICAM-1 και VCAM-1 (-0,10,1). Στην παρούσα μελέτη, η χρόνια κατανάλωση αλκοόλ δεν φάνηκε να επιδρά σημαντικά στους δείκτες της οξειδωτικής δραστηριότητας του πλάσματος που μελετήθηκαν (p>0,05 για όλες τις συγκρίσεις). Τα επίπεδα της οξειδωμένης LDL και οι δείκτες της οξειδωτικής κατάστασης του ορού και της οξειδωτικής-αντιοξειδωτικής ισορροπίας δεν μεταβάλλονταν σημαντικά στις διαφορετικές κατηγορίες κατανάλωσης αλκοολούχων σκευασμάτων. Συμπερασματικά, η κατανάλωση αλκοόλ αυξάνει την αρτηριακή πίεση στους άνδρες αλλά όχι στις γυναίκες. Η αύξηση όμως αυτή γίνεται σημαντική σε κατανάλωση μεγαλύτερη από 2 ποτήρια/ημέρα. Η επίδραση της κατανάλωσης αλκοόλ στα μόρια προσκόλλησης και στους δείκτες οξειδωτικού stress που μελετήθηκαν δεν ήταν σημαντική, με μοναδική εξαίρεση τα αυξημένα επίπεδα ICAM-1 σε εργαζομένους που ανέφεραν αποχή από το αλκοόλ συγκριτικά με τους υπόλοιπους. Τα αποτελέσματα αυτά πιθανόν να υποδεικνύουν ότι η χρόνια και λελογισμένη κατανάλωση αλκοολούχων σκευασμάτων δεν επιδρά σημαντικά σε αυτές τις διεργασίες και συνεπώς η μείωση της καρδιαγγειακής νοσηρότητας από την ήπια κατανάλωση αλκοόλ πιθανόν να οφείλεται σε άλλους παθοφυσιολογικούς μηχανισμούς

The medical and socioeconomic burden of heart failure: A comparative delineation with cancer

Cardiovascular disease and cancer represent the two leading causes of death in the Western World. Still, cardiovascular disease causes more deaths and more hospitalizations than cancer. Although mortality rates of both conditions are generally declining, this is not true for heart failure (HF). The prevalence of HF is increasing, although its incidence has been stabilized, mainly because of the population aging. The survival of patients with HF is overall worse than those with cancer. In addition, HF failure is the most common reason for hospitalization in the elderly, while hospitalization for HF is followed by adverse prognosis and represents the main contributor to the huge financial expenditure caused by the syndrome. The outcome of HF patients and thus its medical and socioeconomic burden may be improved by the more efficient in-hospital management of patients, the enhancement of adherence to guideline-recommended therapies, the identification and treatment of comorbid conditions and the introduction of more effective medical therapies. (C) 2015 Elsevier Ireland Ltd. All rights reserved

Association between copayment, medication adherence and outcomes in the management of patients with diabetes and heart failure

Objective: To determine the association between copayment, medication adherence and outcomes in patients with Heart failure (HF) and Diabetes Mellitus (DM). Methods: PubMed, Scopus and Cochrane databases were searched using combinations of four sets of key words for: drug cost sharing; resource use, health and economic outcomes; medication adherence; and chronic disease. Results: Thirty eight studies were included in the review. Concerning the direct effect of copayment changes on outcomes, the scarcity and diversity of data, does not allow us to reach a clear conclusion, although there is some evidence indicating that higher copayments may result in poorer health and economic outcomes. Seven and one studies evaluating the relationship between copayment and medication adherence in DM and HF population, respectively, demonstrated an inverse statistically significant association. All studies (29) examining the relationship between medication adherence and outcomes, revealed that increased adherence is associated with health benefits in both DM and HF patients. Finally, the majority of studies in both populations, showed that medication adherence was related to lower resource utilization which in turn may lead to lower total healthcare cost. Conclusion: The results of our systematic review imply that lower copayments may result in higher medication adherence, which in turn may lead to better health outcomes and lower total healthcare expenses. Future studies are recommended to reinforce these findings. (C) 2017 Elsevier B.V. All rights reserved

Quality of life measurement in patients with hypertension in Cyprus

Cardiovascular diseases and hypertension may have a significant impact on the quality of life of those who suffer from these conditions. The aim of the present study was to measure health-related quality of life among Cypriot patients suffering from hypertension and/or dyslipidaemia, as well as to investigate any temporal changes in their quality of life at 3 and 6 months from the initial visit. Methods: A stratified random sampling method was used in this follow-up multi-centre study to select a representative sample of physicians who treat patients with hypertension in both public and private sector outpatient hospital clinics and physician offices. The participants were diagnosed by the physician according to the 2007 European guidelines for the management of arterial hypertension. The EQ-5D questionnaire was employed to measure self-assessed quality of life among these patients. Six hundred and fifty-four patients were recruited by physicians and agreed to participate, while 528 of them successfully completed EQ-5D at baseline and two subsequent phases (at 3 and 6 months), representing a response rate of 80.7%. Results: A total of 39.6% of the respondents reported problems in one or more of the EQ-5D dimensions. This was more apparent in the case of anxiety and depression. There appeared to be statistically significant improvements with regard to mobility, usual activities, pain/discomfort and anxiety/depression dimensions between the initial visit and on first follow up, as well as subsequently. Median (interquartile range) EQ-5D index scores were 0.97 (0.19), 0.97 (0.19) and 0.97 (0.17) at first visit, first follow-up and second follow-up respectively (p<0.001). Also, median EQ-5D VAS scores were 80 (20), 85 (10) and 90 (15) at the initial, first follow-up and second follow-up visit respectively (p<0.001). Median EQ-5D VAS scores increased over time amongst all socio-demographic and risk groups of participants. Conclusion: Hypertension had little association with mobility and physical activities, indicating that performing physical activities was not limited by hypertension. However, hypertension seems to be more strongly related to anxiety and depression

Economic evaluation of a single-pill triple antihypertensive therapy with valsartan, amlodipine, and hydrochlorothiazide against its dual components

The aim of this study was to compare the cost-utility of the first available single-pill triple combination antihypertensive therapy containing valsartan (V), amlodipine (A) and hydrochlorothiazide (H), with each of the same components dual combinations in patients with moderate to severe hypertension. A Markov model with eight health states was constructed. The short-term effect of antihypertensive treatment on blood pressure was extrapolated through the Hellenic SCORE and Framingham risk equations, estimating the long-term survival and quality-adjusted life-years (QALYs) saved. Costs and outcomes were evaluated over lifetime, divided into annual cycles and discounted at 3.0 % with 2013 as reference year. The analysis was conducted by the Greek third-party-payer perspective. The triple combination treatment cost was estimated at (sic)16,525 compared to (sic)15,480 for V/A, (sic)14,125 for V/H and (sic)11,690 for A/H. The QALYs saved with the triple combination were 12.76 vs. 12.64, 12.61 and 12.38 for double combinations respectively. The incremental cost-effectiveness ratio of the triple combination versus V/A and A/H was far lower than the Greek GDP per capita ((sic)8,690/QALY and (sic)12,695/QALY, respectively) and really close for V/H ((sic)16,192/QALY), suggesting V/A/H combination to be cost-effective. Extensive sensitivity analyses confirmed the robustness of the results. The probability that the triple combination is cost effective was more than 90 % at a willingness-to-pay threshold of (sic)18,000/QALY. This is the first study to evaluate the cost-utility of a single-pill triple combination. The single-pill V/A/H therapy is a cost-effective antihypertensive choice for the treatment of moderate to severe hypertension, compared to its dual components