Demonstrating the Benefits of Antihypertensive Nighttime Dosing and Indapamide Usage in Hypertension Management.

Background: Uncontrolled hypertension, specifically nocturnal hypertension, increases the risk for significant clinical outcomes. Evidence on the use of nighttime antihypertensives is scant and conflicting. In addition, hydrochlorothiazide continues to be the primary thiazide used despite being the least potent. Objective: The primary purpose of this study was to evaluate instituting nighttime dosing to control hypertension and compare the short-term effectiveness of blood pressure control with indapamide versus hydrochlorothiazide. Methods: This was a retrospective, observational study. Participant inclusion criteria consisted of patients 18 years of age or older, a current diagnosis of hypertension, and hypertension that required medical therapy. The investigator documented whether a patient was taking at least one antihypertensive at night versus all morning medications, as well as the use of indapamide versus hydrochlorothiazide. The patient's baseline and first follow-up blood pressure readings were documented. The primary outcome was to determine whether including nighttime dosing in antihypertensive regimens is more effective than all morning antihypertensive regimens. The secondary outcome was to determine whether indapamide was more effective than hydrochlorothiazide. Results: A total of 64 patients were included in the study. Twenty-eight patients were taking >1 nighttime antihypertensives versus 32 patients on all morning medications. Patients on at least one nighttime medication demonstrated greater systolic blood pressure reduction. There was no difference in blood pressure reduction between indapamide and hydrochlorothiazide. Conclusion: The study findings support the use of nighttime dosing to improve blood pressure management. The results on the effectiveness of indapamide versus hydrochlorothiazide conflict with previous research.

Virtual Versus Paper-based Cases in Reinforcing the Collect and Assess Elements of the Pharmacists' Patient Care Process.

Objective. To compare pharmacy students' perceptions about and performance when using paper-based versus virtual patient cases to reinforce knowledge of the collect and assess elements of the Pharmacists' Patient Care Process (PPCP). Methods. Twenty-seven pharmacy students enrolled in an ambulatory care elective course were randomized to receive either paper-based cases or virtual patient cases for three weeks. They then crossed over to receive the alternative case format for the next three weeks. Each student received a score for their performance on questions related to the collect and assess elements of the PPCP. Students completed a survey and participated in a focus group to evaluate their perceptions of each learning method. Statistical analyses were performed on all data collected. Results. Students' performance (n=27) was better on the assess questions of the PPCP when they used paper-based patient cases than when they used virtual patient cases. The only difference in students' perceptions was related to the collect element, as students favored using paper-based patient cases over virtual patient cases when collecting subjective and objective information. Students who participated in the focus groups believed that the virtual patient cases provided a more realistic and engaging experience in addition to promoting critical thinking. Conclusion. While paper-based patient cases allowed pharmacy students to quickly identify and "collect" relevant information, increased use of virtual patient cases may enhance students' comfort level with and ability to "assess" actual patients.

Lixisenatide: A New Option for Managing Type 2 Diabetes.

Objective: To evaluate the clinical role of Adlyxin (lixisenatide) in the treatment of type 2 diabetes mellitus. Data Sources: A MEDLINE search of the English language indexed from January 2013 to April 2017 was conducted using the search terms lixisenatide, safety, and efficacy. Study Selection and Data Extraction: Studies including human subjects were utilized to assess the efficacy and safety of lixisenatide. Data Synthesis: Lixisenatide is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) that increases glucose-dependent insulin release, decreases glucagon secretion, and slows gastric emptying. Clinical trials demonstrate that lixisenatide is an effective add-on pharmacotherapy option to achieve goal HbA1c levels. For example, in the Get Goal-Duo 1 study, HbA1c decreased to 7.0% in the lixisenatide group versus 7.3% in the placebo group (least square mean difference of -0.3%, P < .0001). Furthermore, lixisenatide was shown to be superior to liraglutide in reducing postbreakfast glucose levels. Conclusions: Clinical studies have demonstrated that lixisenatide is a safe and effective treatment option for type 2 diabetes mellitus. In addition, it may be a safer and equally effective option to rapid-acting insulin.