HYVET - High time we control Hypertension in elderly

HYVET - Control hypertension ( target of under 150/80 mm Hg in 80+ years old). This trial gave all us clinicians the definite answer to the question- should we control hypertension in elderly and its a definite "YES"

HYVET published in NEJM showed use of Indapamide (1.5 mg SR) with or without Perindopril (2mg or 4mg) resulted in a non significant reduction of 30% in fatal or non fatal stroke (defined primary end point) BUT showed a significant reduction in heart failure(64%), all cause mortality(21%), fatal stroke(39%), cardiovascular mortality due to stroke, MI, Heart failure by 34%.

Points to remember:

1. Treat for Hypertension in elderly
2. Remember to check for postural drop at every visit

ENHANCE - Ezetimibe in shadow

This quarter also saw the results of ENHANCE study being published.

ENHANCE revealed no effect on Carotid Intima thickness, a surrogate marker of atherosclerosis, inspite being able to lower cholesterol. This trial has been a big blow to the drug which is prescribed in combination with statins.

Both the editorials published in NEJM on the trial advise clinicians to consider Niacin, fibrates, and resins when diet, exercise, and a statin have failed to achieve the target. Ezetimibe to be reserved for patients who cannot tolerate the above agents.

Now a larger trial IMPROVE IT is being conducted with 18000 participants and being studied for harder end points (in research parlance - clinical events like stroke, MI, death).Results of IMPROVE IT are expected in 2012.

Landmark trials for Internist in Q1 2008

The Q1 of this year has seen lot of landmark studies being published. I have added a few studies which should be remembered in daily patient care.
ONTARGET, ENHANCE, HYVET, CREATE registry(INDIA)

First off the ONTARGET, one of the largest antihypertensive trials done to date to answer one of the always eluding questions of combination ACEI and ARB therapy and which is better ACEI or ARB. Results showed

Telmisartan is as efficacious as (or non inferior to) Ramipril in Hypertension management. Also, combination therapy is associated with symptomatic hypotension, more hyperkalemia and renal dysfunction.

Will post on the other landmark trials in the next post.

Power Doc's shared feed - the best articles and must read articles for the internist

Power Doc's shared items feed added to the blog.
I selected these articles - some things you should know in your residency and as an internist. You should be updated with articles in this feed. I shall also try to post some articles to read from journals.
Will keep updating this feed! Watch out
"Learn Medicine - the EBM way"

Feed can also be accessed which includes articles summaries in a full page window

http://www.google.com/reader/public/atom/user/11294863187412973894/state/com.google/broadcast