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Source: American journal of hypertension
PANSAID Trial (2019): Paracetamol and Ibuprofen on Morphine Consumption in the Total Hip Arthroplasty
PANSAID Trial Summary: Hojgaard et al. randomized 556 patients who were scheduled to undergo total hip arthroplasty to pain control with a combination of paracetamol + ibuprofen or any one of them with placebo. The primary objective was to assess if post-op morphine requirement decreases with the use of adjunctive pain medications. The results showed significant decrease in morphine requirement when paracetamol and ibuprofen were used in combination full dose. Ibuprofen alone was also found to have signficant benefit in terms of decreasing the morphine requirement therefore, the authors concluded that isolated ibuprofen can be used as an adjunct pain medication to lessen the requirement of patient-controlled morphine in patients who undergo total hip arthroplasty.
SPRINT MIND Trial (2019): Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia
SPRINT-MIND Trial Summary: Authors of this trial randomized 9,361 adults aged 50 years or older with hypertension but without diabetes or history of stroke to either intensive control (SBP < 120 mmHg) or standard control (SBP < 140 mmHg). The objective was to assess if intensive blood pressure control reduces the occurrence of dementia as compared moderate control. The results showed no difference in terms of adjudicated probable dementia (P=0.10). However, it did show a significant decrease in mild cognitive impairment in patients whose BP was intensively controlled. (P=0.007) The authors of SPRINT-MIND trial concluded that in ambulatory adults with hypertension, intensive BP control (SBP < 120 mmHg) did not reduce the risk of probable dementia but significantly reduced mild cognitive impairment.
2018, N3 fatty acid supplements for prevention of CVD and cancer, NEJM
2018, Vitamin D3 for prevention of CVD and cancer, NEJM
2006, Effect of mammographic screening from age 40 years on breast cancer mortality at 10 years, The Lancet
2018, N3 fatty acid supplements for primary prevention in DM2, NEJM
2018, Aspirin for primary prevention in patients with Diabetes mellitus, NEJM
2018, Effect of Aspirin in elderly at moderate CVD risk | LANCET
2018, Effect of Aspirin on CV Events and Bleeding in the Healthy Elderly | NEJM
2018, Discharging from ICU vs from medicine wards, JAMA Internal Medicine
The SPYRAL HTN-ON MED trial was a large multicenter global scale trial that compared the effect of renal denervation + antihypertensive medications with antihypertensive medications alone. The results were significantly in favor of renal denervation in patients who had uncontrolled hypertension noticed in the clinic settings. Check out the visual abstract and following text for the trial summary.
SPYRAL HTN-ON MED trial Summary
The role of the sympathetic nervous system in the pathogenesis of hypertension (HTN) is well known. Activation of afferent sympathetic fibers results in renin release, retention of sodium, and reduction in renal blood flow that lead to the increase in blood pressure (BP) values. Hypertension usually requires life-long medication regimen; however, many studies have highlighted the averseness of many patients to maintain the stable regimen.
Recently, surgical renal denervation (RDN) has emerged as an efficient way of diminishing the renal sympathetic stimulation, decreasing the release of renin, while maintaining the normal glomerular filtration rate and renal blood flow.
SPYRAL HTN-ON MED trial is a randomized, single-blind, sham-controlled proof-of-concept trial carried out by Kandazi DE, et al. to assess the safety and efficacy of renal denervation on BP in patients with uncontrolled HTN who were on antihypertensive medication. The RDN of the main renal artery and accessory branches was performed with a Spyral multi-electrode radiofrequency ablation device. The primary results of the first 80 patients in the SPYRAL HTN-ON MED trial were published in 2018, which demonstrated a significant decrease in office and 24-hour ambulatory BP from baseline to 6 months in RDN group compared to sham-control, with a mean drug adherence of 60%.
The previous SPYRAL HTN-OFF MED trial of the SPYRAL series by Townsend RR, et al. was published in 2017. This trial used the similar ablation device as in HTN-ON MED trial but was conducted in the absence of antihypertensive medications. This trial also demonstrated a significant reduction in 24-hour ambulatory BP from baseline at 3 months follow-up.
Furthermore, the reduction in systolic BP of approximately 5.5 to 9 mmHg in these SPYRAL trials corresponds to the effect of one antihypertensive drug. It is also important to note that the short-term safety profile of this new intervention is favorable with no major adverse effects recorded. These results have shown a promising future of RDN in the treatment of HTN, especially in patients with medication noncompliance or those with adverse effects of medication.
However, before RDN becomes a mainstream management option for the treatment of HTN, further research needs to show the improvements in cardiovascular morbidity and mortality with the use of RDN. Additionally, further research is also needed to establish a long-term safety beyond the initial 6 months post-procedure.
Summary Reviewer: Mustafa Rahim, MD, FACP, FASPC (1)
1. Department of Medicine, West Virginia University Robert C. Byrd Health Sciences Center, WV
The current USPSTF guidelines for screening of abdominal aortic aneurysm were published in 2014. The guidelines recommend one time ultrasound guided screening for men smokers between age of 65-75 years. On the other hand recommendations are against screening in non smokers women. Check out the MASS trial to understand the source and literature background of guidelines.
USPSTF/ACC/AHA guidelines for Statin Use for the Primary Prevention of Cardiovascular Disease in Adults
The USPSTF and ACC/AHA guidelines for statin use in adults aged 40-75 years are consistent over level of recommendation. Adults who have no history of cardiovascular disease but have 1 or more risk factors for developing CVD along with >10% ASCVD risk are recommended to be started on low- to moderate dose statin. (USPSTF = B). The ACC/AHA however recommends moderate to high dose statin for ASCVD risk of >7.5% for primary prevention (ACC/AHA Level I). The above visual abstract summarizes both the societies’ recommendations in to one easy to use graphic.
The STRIVE trial introduced Erenumab, a once monthly self injectable drug for prevention of episodic migraine. It’s calcitonin-gene-related peptide (CGRP) antagonist. It is recently approved by FDA for its use in migraine. Check out the STRIVE trial visual summary and visual abstract to understand how effective was Erenumab for episodic migraine.