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Roshini Claire Anthony, 20 Mar 2018

Individuals with type 2 diabetes (T2D) who initiate therapy with sodium glucose cotransporter-2 (SGLT-2) inhibitors have lower risks of all-cause death and cardiovascular (CV) outcomes, specifically myocardial infarction (MI) and stroke, compared with those who initiate other glucose-lowering therapies, according to results from the CVD-REAL* 2 study.

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Medication not recommended for low-risk patients with mild hypertension

Tristan Manalac
09 Nov 2018

Initiating pharmacologic interventions in low-risk patients with mild hypertension may lead to a higher risk of adverse events, such as syncope and electrolyte abnormalities, according to a recent study.

While no link in elevated mortality risks was observed, “[t]he findings suggest that physicians should be cautious when initiating treatment in low-risk patients with mild hypertension, particularly because such an approach may affect millions of individuals with little evidence of benefit,” said researchers.

Accessing an electronic health records database, researchers enrolled 19,143 mildly hypertensive patients (mean age 54.7±11.8 years; 55.9 percent female) with low cardiovascular disease (CVD) risk and who had been exposed to any antihypertensive medication. Over a median follow-up of 5.8 years, the overall mortality rate in this group was 4.08 percent. [JAMA Intern Med 2018;doi:10.1001/jamainternmed.2018.4684]

This was not significantly different from that of the nonexposed control group (4.49 percent, risk difference, 0.41 percent; 95 percent CI, 0.02–0.85 percent; hazard ratio [HR], 1.02; 0.88–1.17; p=0.81), which was similar in size and demographic composition (mean age 54.9±12.2 years; 55.5 percent female).

Similarly, the risks of CVD (HR, 1.08; 0.96–1.25; p=0.23), stroke (HR, 0.97; 0.78–1.21; p=0.76), myocardial infarction (MI; HR, 1.00; 0.80–1.25; p=0.98), non-MI acute coronary syndrome (ACS; HR, 1.19; 0.74–1.91; p=0.47) and heart failure (HR, 1.34; 0.96–1.86; pp=0.09) were statistically comparable between those with and without antihypertensive exposures.

The effect of baseline antihypertensive treatment remained mostly null upon sensitivity analysis, except for its effect on non-MI ACS, which reached statistical significance upon adjusting for baseline cardiovascular risk (HR, 0.54; 0.33–0.89; p=0.02).

“Even in sensitivity analyses adjusting the propensity score for previous or imputed risk score, the observed treatment benefit for cardiovascular outcomes was minimal, with only non-MI ACS associated with a significant risk reduction with treatment,” said researchers.

On the other hand, antihypertensive medication use was associated with significantly elevated risks of adverse events such as hypotension (HR, 1.69; 1.30–2.20; p<0.001), syncope (HR, 1.28; 1.10–1.50; p=0.02), electrolyte abnormalities (HR, 1.72; 1.12–2.65; p=0.01) and acute kidney injury (HR, 1.37; 1.00–1.88; p=0.048).

“There was evidence to suggest that baseline treatment exposure may be associated with an increased risk of adverse events, with a number needed to harm after 5 years of treatment of 135 for syncopal outcomes,” said researchers.

In the present study, low CVD risk was defined according to comorbidities. Patients with a history of CVD, diabetes, atrial fibrillation, chronic kidney disease or left ventricular hypertrophy were not eligible for inclusion. Those with family histories of premature heart disease were also excluded.

“Physicians should therefore be cautious when initiating new treatment in this population, and patients should be made aware of the limited evidence of efficacy for treatment in low-risk individuals,” said researchers.

“These findings may be particularly relevant for younger patients with mild hypertension, because as these individuals age, they are likely to develop higher risk and moderate or severe hypertension, for which the benefits of treatment are more established,” they added.

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Most Read Articles
17 Feb 2019
In patients with type 2 diabetes (T2D), sodium-glucose cotransporter 2 (SGLT2) inhibitor monotherapy, particularly canagliflozin, exerts greater effects on weight compared with metformin and dipeptidyl peptidase 4 (DPP-4) inhibitors or gliptins, according to the results of a meta-analysis.
Roshini Claire Anthony, 20 Mar 2018

Individuals with type 2 diabetes (T2D) who initiate therapy with sodium glucose cotransporter-2 (SGLT-2) inhibitors have lower risks of all-cause death and cardiovascular (CV) outcomes, specifically myocardial infarction (MI) and stroke, compared with those who initiate other glucose-lowering therapies, according to results from the CVD-REAL* 2 study.

20 Feb 2019
A recent study has shown that compounded topical pain creams are only as effective as placebo creams in the treatment of localized chronic pain. Their costs are also higher compared with approved compounds, which should discourage routine use.
Pearl Toh, 24 Jul 2018
SGLT-2* inhibitors and GLP-1** agonists were associated with better survival compared with DPP-4*** inhibitors or control (placebo or no treatment) in patients with type 2 diabetes (T2D) who were inadequately controlled on metformin, according to a large network meta-analysis of 236 randomized trials.