Managing hypertension

One of the most common conditions in the world, and yet despite the vast array of medications we have, the treatment of hypertension is still exceedingly variable. To even up the stakes, here is the latest guideline from the Americans on the management of hypertension.

Read it here

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Atherosclerotic renal artery stenosis – stents or tablets?

The recent AHA meetings have provided a littany of articles to look at, with the most recent coming in an online first form over at the New England Journal of Medicine. This topic however has been looked at before (ASTRAL and STAR), and now this new trial titled CORAL aims to put the argument to bed once and for all.  Continue reading

Transcatheter aortic valve replacement

This one is more for the cardiologists among you, however it is a technique that is becoming increasingly common. Transcatheter aortic valve replacement or implantation is generally indicated for the treatment of severe symptomatic aortic stenosis in patients with inoperable or high risk but operable comorbidities. Here, the results from all US TAVR cases (almost eight thousand cases) are presented.

So, what do you need to know?

  • average age was 84
  • About half are women
  • the STS predicted mortality was 7% – actual in hospital mortality was 5.5%, and 7.6% at 30 days
  • 64% were done from the femoral approach
  • there was a 2% stroke rate
  • 1.9% required dialysis due to renal failure
  • 0.5% of patients required intervention

An interesting read regarding TAVR/TAVI in general, and useful to provide more information to patients. Check it out here.

 

source | Journal of the American Medical Association

image | Heart Hospital of Austin

Mechanical CPR

A few people have been waiting for these trial results for a while – a comparison between mechanical and manual CPR. A few of these devices have been around for a while, with different methods used in each. This article in JAMA covers the LINC trial, looking at 2589 patients with out of hospital cardiac arrests across 5 years.  Continue reading

Controlling warfarin

One of the reasons for the surge in popularity of the novel anticoagulant agents (dabigatran, apixaban and rivaroxaban) over the past few years has been the assurance of therapeutic anticoagulation. Warfarin users are not always within the therapeutic range, with some studies quoting subtherapeutic INRs in 30% of patients. This study in CHEST looks at the factors affecting the quality of anticoagulation control based on the AFFIRM study.  Continue reading

resources

If you haven’t seen our resources page yet, please check it out! I’ve included sites that I use as well as a collection of excellent textbooks for general medicine (which I’ve just updated with direct links for you to check out the book itself). Over the next few months, I’ll update the links section to make it a little more user friendly, with a link to every recent guideline and review on the big topics. If you have any ideas for improvements, please, let me know!