Executive summary of the 2020 Clinical practice guidelines for the management of Dyslipidemia in the Philippines / Journal of the ASEAN Federation of Endocrine Societies

@#Dyslipidemia is a cardiovascular risk factor that is increasing in prevalence in the country. The need to treat and manage elevated cholesterol levels, both pharmacologic and non-pharmacologic, is of utmost importance. Different medical societies and groups bonded together to formulate the 2020 Philippine Clinical Practice Guidelines for dyslipidemia. The group raised nine clinical questions that are important in dyslipidemia management. A technical working group analyzed the clinical questions dealing with non-pharmacologic management, primary prevention for both non-diabetic and individuals with diabetes, familial hypercholesterolemia, secondary prevention, adverse events of statins and the use of other lipid parameters as measurement of risk for cardiovascular disease. Randomized controlled trials and meta-analyses were included in the GRADE-PRO analysis to come up with the statements answering the clinical questions. The statements were presented to a panel consisting of government agencies, members of the different medical societies, and private institutions, and the statements were voted upon to come up with the final statements of the 2020 practice guidelines. The 2020 CPG is aimed for the Filipino physician to confidently care for the individual with dyslipidemia and eventually lower his risk for cardiovascular disease.

Blood pressure-lowering efficacy of Spironolactone in patients with Resistant Hypertension: A meta-analysis

Introduction@#Resistant hypertension (RH) is defined as a blood pressure (BP) reading that remains above goal despite concurrent use of three optimally dosed antihypertensives of different classes, including a diuretic. Spironolactone, a mineralocorticoid receptor antagonist, has shown significant benefit in reduction of BP in recent trials and is used empirically as an add-on therapy for RH. The researchers’ objective is to evaluate the BP-lowering efficacy of spironolactone in patients with resistant hypertension.@*Methods@#A meta-analysis was performed on randomized controlled trials (RCTs) comparing office or home BP reduction using spironolactone with placebo or an alternative drug regimen on top of standard-triple drug therapy among patients with RH. The study was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).@*Results@#Five RCTs were included comprising a total of 662 patients. Three of these studies were found to have low risk of bias while two had unclear risk of bias. Compared to placebo, the addition of spironolactone significantly decreased office systolic BP (weighted mean difference [WMD]= -16.33, 95% confidence interval [CI]=-24.68 to -7.97, P=0.0001) and office diastolic BP (WMD=-6.12, 95% CI= -9.35 to -2.89, P=0.0002). Compared to an alternative drug regimen, additional spironolactone resulted in a significantly greater reduction in office systolic BP (WMD=-4.58mmHg, 95% CI=-7.19, -1.97, P= 0.0006) and home systolic BP (WMD= -4.33, 95% CI= 5.55, -3.12, P< 0.00001); while the addition of spironolactone had no significant difference compared to an alternative drug regimen in reducing office diastolic BP (WMD=-3.35, 95% CI=-12.08 to +5.38, P=0.45) and home diastolic BP (WMD= 0.00, 95 % CI=-0.73 to 0.73, P=1.0).@*Conclusion@#Spironolactone, when added to triple-drug anti-hypertensive therapy, showed significant reduction of systolic office and home BP. It should be considered as the add-on medication of choice for BP reduction in patients with RH.

Terazosin as first line preoperative blockade in Filipino patients diagnosed with pheochromocytoma / Journal of the ASEAN Federation of Endocrine Societies

@#Pheochromocytoma, a rare cause of hypertension, is potentially fatal if left untreated. Definitive treatment is resection of the mass. Preoperative blockade is important to improve intraoperative hemodynamic stability and reduce morbidity during resection. Phenoxybenzamine, a non-selective alpha adrenergic blocker, has been widely used as preoperative blockade, but is unavailable in the Philippines. Terazosin, a selective alpha 1 antagonist and is widely available as treatment for benign prostatic hypertrophy, has been documented in reports as a suitable preoperative drug in reducing blood pressure in pheochromocytoma patients. The objective is to present four cases of Filipino pheochromocytoma patients who were treated with terazosin as first line preoperative blockade. Four Filipino patients from the Philippine General Hospital were diagnosed with pheochromocytoma based on biochemical and imaging studies. They were started on different doses of terazosin, the maximum dose as high as 4 mg per day. One patient experienced orthostatic hypotension at this dose, but was resolved after reducing the dose to 3 mg per day. A beta blocker (metoprolol on 3 cases, carvedilol) was added for reduction of the symptoms. One patient was also diagnosed with diabetic ketoacidosis, and was treated as such. Two patients experienced labile changes with blood pressure during resection but were resolved with the use of intravenous nicardipine for elevated blood pressure, and crystalloids during bouts of hypotension. All of the patients' blood pressure returned to normal after resection of the mass. Terazosin, a selective alpha 1 antagonist, at a maximum dose of 4 mg per day, may be safely given to Filipino patients diagnosed with pheochromocytoma as first line preoperative blockade.