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Hypertension poses a challenge to public health as well as to the medical science. Final metabolite of purine in humans is uric acid, increased serum level of which is associated with cardio-renal risk, although serum uric acid (SUA) level appears to have different effects on blood pressure (BP), depending on level and how long subjects were exposed. We wanted to study the association between hyperuricemia and hypertension, in various aspects, in the context of new 2017 ACC/ AHA High Blood Pressure Clinical Practice Guidelines.METHODSThe study was conducted in a tertiary care hospital, Agartala, Tripura. It is a case control study. SUA estimation was in 160 hypertensive patients and 160 normotensive controls, by using uricase method. SPSS version 24 was used for data entry and analysis. Chi square test and unpaired t test were used, wherever applicable.RESULTSOut of 320 subjects, who were included in the study, 160 subjects were hypertensive and 160 subjects were normotensive. There was strong association between hypertension and hyperuricemia. Hyperuricemia is more common in males and in patients with stage II hypertension.CONCLUSIONSThe association between hyperuricemia and hypertension, has long been recognized. It remains unresolved whether the association of high uric acid level with high blood pressure is solely because of the underlying renal and metabolic abnormalities. Association of hyperuricemia and hypertension indicated that, hyperuricemia might be a target for the proposed therapeutic evaluation for the prevention of hypertension and provided impetus for the future design research work including interventional studies.
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Background: In November, 2017, the American College of Cardiology (ACC) and American Heart Association (AHA) released new guidelines for classification of hypertension among adults. JNC 7 guidelines are most used till now. The present study aimed to measure the burden of hypertension among adult population using new ACC/AHA guidelines and to compare it with JNC 7. Method: A descriptive cross sectional study was carried over a period of one month as a part of MBBS student project. Blood pressure of hospital visitors/attendants was measured using Omron HEM-8711 blood pressure monitor with standard technique. A total of 437 participants were got measured their blood pressure. Result: 31.6% of participants self-reported their hypertensive state. Out of 299 participants who were now aware about their blood pressure status, 55% labelled as hypertensive using new ACC/AHA guidelines as compared to only 22% with earlier JNC 7 guidelines.
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Our previous research found seven specific factors that cause system delays in ST-elevation Myocardial infarction management in developing countries. These delays, in conjunction with a lack of organized STEMI systems of care, result in inefficient processes to treat AMI in developing countries. In our present opinion paper, we have specifically explored the three most pertinent causes that afflict the seven specific factors responsible for system delays. In doing so, we incorporated a unique strategy of global STEMI expertise. With this methodology, the recommendations were provided by expert Indian cardiologist and final guidelines were drafted after comprehensive discussions by the entire group of submitting authors. We expect these recommendations to be utilitarian in improving STEMI care in developing countries.
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OBJECTIVE: Atrial fibrillation (AF) guidelines have been published in the USA and Europe. Recently, the USA and Europe have updated their guidelines, respectively. These new AF guidelines help in addressing key management issues in clinical situations. This study, therefore, systematically compared guidelines for rate and rhythm control pharmacotherapy of patients with AF between the USA (American College of Cardiology and American Heart Association, ACC/AHA) and Europe (European Society of Cardiology, ESC). METHODS: This study investigated and compared American guidelines (2014) and European guidelines (2010 and 2012). RESULTS: Generally, there are four meaningful differences between ACC/AHA and ESC guidelines. Important differences are treatment classification system, level of recommendation, drug list, and dosage. In addition, ACC/AHA described pharmacokinetic drug interactions for antiarrhythmic drugs. ESC emphasized ECG and atrioventricular nodal slowing as feature of antiarrhythmic drugs. CONCLUSION: This research addresses important use of anti-arrhythmic drugs and movement to accept recent recommendations in Korea. For the successful application of the guidelines, a role of pharmacists is crucial in clinical situation.
Subject(s)
Humans , American Heart Association , Anti-Arrhythmia Agents , Atrial Fibrillation , Cardiology , Classification , Drug Interactions , Drug Therapy , Electrocardiography , Europe , Korea , PharmacistsABSTRACT
Revisamos las nuevas Guías de la AHA/ACC para el tratamiento de la hipercolesterolemia. El enfoque general de tratamiento está orientado a iniciar fármacos en fases iniciales, incluso con estatinas en casos de prevención primaria. En fecha próxima se revisará y analizará la NOM-037-SSA2-2012, para la prevención, tratamiento y control de las dislipidemias. En lo general, la propuesta de la NOM coincide con las nuevas Guías Norteamericanas; no obstante, consideramos que cada caso debe individualizarse.
We revised the new 2013 ACC/AHA Guideline on the treatment of hypercholesterolemia to reduce atherosclerotic cardiovascular disease in adults. Treatment is essentially oriented to the early implementation of pharmacological interventions, including the use of statins for primary prevention. In the near future, the Mexican NOM-037-SSA2-2012, for prevention and treatment of dyslipidemia will be analyzed. Substantially, the Mexican NOM-037-SSA2-2012 concords with the new 2013 ACC/AHA Guideline, withal we consider that treatment should always be individually adjusted.
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OBJECTIVE: Patients with acute coronary syndrome (ACS) are typically managed with dual antiplatelet therapy of acetylsalicylic acid (aspirin) and P2Y12 receptor inhibitor. In this study, we discussed current and previous antiplatelet therapy guidelines and compared with guidelines of the USA (ACC/AHA), Europe (ESC) and Korea (KSC). METHOD: This study investigated from ACC/AHA Joint Guidelines (the USA), ESC Clinical Practice Guidelines (Europe) and Korea Society of Interventional Cardiology (Korea) web site, respectively. RESULTS: It is significant that difference between the current and the previous guidelines was integration of terminology from clopidogrel to P2Y12 receptor inhibitors since prasugrel and ticagrelor, new antiplatelet drugs, has been added. The other difference was all three guidelines has differences in dose of aspirin. The most notable difference was class of recommendation (COR) in P2Y12 receptor inhibitors. ACC/AHA and Korean guidelines recommend clopidogrel, prasugrel, and ticagrelor with COR IB; whereas, ESC recommend prasugrel and ticagrelor with IB which is higher than clopidogrel with IC. CONCLUSION: This research addresses important movement to revise the Korean existing guideline recommendations. New Korean antiplatelet therapy guideline should be avoiding obvious differences in ACC/AHA and ESC guidelines and harmonizing international guidelines.
Subject(s)
Humans , Acute Coronary Syndrome , Aspirin , Cardiology , Europe , Joints , Korea , Prasugrel HydrochlorideABSTRACT
Management of high blood cholesterol is the key point for the treatment and prevention of Atherosclerotic Cardiovascular Disease (ASCVD). Till 2013, Adult Treatment Panel III (ATP III) report was the guideline for the physician for blood cholesterol management. The main feature of this guideline was to achieve a particular target cholesterol level by lifestyle modification, dietary changes and lipid-lowering drugs. But the recently released American College of Cardiology (ACC) and American Heart Association (AHA) guidelines shifted attention to Statin use at high-, moderate- or low-intensity instead of chasing a cholesterol goal. This article reviews the main features of this new guideline comparing to the previous one, where appropriate.
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The new 2013 ACC/AHA Guideline is quite different from the previous NCEP-ATP III or ESC/EAS guidelines. Although the guideline is simplified and aimed at prevention of ASCVD rather than control of lipid levels, it also raises many questions and debates. If Koreaadopts the new guideline, the number of people to be treated with statins will increase dramatically, which would pose a large costburden on the medical system. Young people with high lifetime ASCVD risk according to the Pooled Cohort Equation would be administered high- or moderate-intensity statins at an earlier stage, and the older generations would likely be overtreated. The equation should be validated in populations other than non-Hispanic whites and African-Americans before final approval as a valid tool for risk calculation. Studies of Korean populations, including several observational epidemiologic studies and RCTs, are required to validate the new guideline in Korea.
Subject(s)
Cholesterol , Cohort Studies , Diabetes Mellitus , Family Characteristics , Hydroxymethylglutaryl-CoA Reductase Inhibitors , KoreaABSTRACT
PURPOSE: Cardiovascular risk assessment of atherosclerotic arterial occlusive diseases is a critical component of preoperative care. Many indexes have been developed to help identify patients at high risk for perioperative cardiac events. We sought to study guideline implementation and clinical outcomes in cardiovascular risk assessment. METHOD: We studied 75 patients who underwent preoperative cardiac risk assessment between 2003 and 2006 at the Kyung Hee University Medical Center. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines were used to stratify the patients. RESULT: The mean age of patients was 67.9 years. When stratified into risk categories according to the ACC/AHA guidelines, 2 patients was high risk group, 51 intermediate risk group, and 22 low risk group. There were 3 perioperative cardiac complications (4.0%) including 2 mortalities (2.7%). There was a trend toward a higher frequency of cardiac complications when there was discordance with the ACC/AHA guidelines, but there was no significant difference (discordance 7.1%, concordance 0%, P=0.251). The guidelines recommended cardiac testing for 44 patients, but 12 patients (27.3%) were tested. The guidelines did not recommend for 31 patients, but additional cardiac tests were done for 10 patients (32.3%) and mainly associated with low risk group. CONCLUSION: Differences between clinician practice and guideline recommendations existed and did not result in a higher frequency of cardiac complications.