Cardiology

Stroke Risk Mitigation: Prescribing and Monitoring anticoagulation in atrial Fibrillation

Atrial fibrillation (AF) heightens the risk of stroke. Patients with AF should have their stroke risk assessed, and high-risk patients should commence on nonvitamin K-dependent oral anticoagulants (NOACs) as the first-line antithrombotic agent. A patient’s reversible bleeding risk factors should be however reviewed and specifically addressed. Antiplatelet agents such as aspirin do not reduce stroke risk but have bleeding risks comparable to NOACs, therefore have no role in stroke risk reduction. Management should also include regular reviews to ensure medication adherence and persistence.

Modern Medicine – Issue 5 2024.

Resistant Hypertension: An Approach to Management

Resistant hypertension (RH) is a prevalent and significant cause of morbidity and mortality. Adverse health outcomes can be significant. True RH must be confirmed by adequate in-office and out-of-office blood pressure (BP) measurements. Common causes of apparent RH include white-coat hypertension, nonadherence with prescribed antihypertensive therapy, inadequate antihypertensive combination therapy and the use of interfering concomitant medications. Obesity, obstructive sleep apnoea and renal parenchymal disease are among the most common contributing features of RH; patients should be screened for secondary causes of hypertension. Management of RH relies on lifestyle measures, pharmacotherapy and interventional approaches, where required.

Modern Medicine – Issue 5 2024.

“Time is Brain” in Acute Ischaemic Stroke Management

Stroke is the second leading cause of death and the third leading cause of long-term disability worldwide. In SA, stroke is the second highest cause of mortality after HIV/AIDS and is among the top ten leading cause of long-term disability, accounting for 25 000 deaths a year and 95 000 years lived with disability.

Modern Medicine – Issue 2 2024

European Society of Hypertension : 2023 Guideline Update

The recently published European Society of Hypertension (ESH) 2023 ESH Guidelines for the management of arterial hypertension is the latest in a long series of high blood pressure (BP) clinical practice guidelines. It closely resembles the 2018 European Society of Cardiology/ESH guidelines, with incremental rather than major changes.

Modern Medicine – Issue 1 2024

Fenofibrate + Statin Found to Reduce Diabetic Retinopathy Progression

Diabetic retinopathy is a significant cause of vision impairment and is predicted to become an increasingly large global public health problem. Diabetic retinopathy often affects those of working age and can have significant health, social and economic implications. Fenofibrate, a peroxisome proliferator-activated receptor alpha (PPAR-a) agonist, has been suggested as an adjunctive therapeutic option for diabetic retinopathy in patients with diabetes and existent diabetic retinopathy.

Modern Medicine – Issue 6 2023

Heart Failure with Reduced Ejection Fraction: Advances in Management

Heart failure (HF) is a leading cause of morbidity and a major burden on healthcare resources. Targeting modifiable risk factors and use of guideline-directed medical therapies in at-risk individuals is a crucial first step in the prevention of HF progression. All eligible patients with HF with reduced ejection fraction should be treated with the ‘big four’ pharmacological drug classes – angiotensin receptor neprilysin inhibitors, beta blockers, mineralocorticoid receptor antagonists and SGLT-2 inhibitors – which have proven benefit in reducing cardiovascular mortality and HF hospitalisation.

Modern Medicine – Issue 6 2023

The Role of Beta-blockers: 2023 ESH Guidelines for Managing Arterial Hypertension

In June, the 2023 European Society of Hypertension (ESH) Hypertension guidelines were published. Overall, the new report closely resembles its predecessor published in 2018. The guidelines confirm the preferred use of renin–angiotensin system blockers, calcium channel blockers and Thiazide/Thiazide-like diuretics, and their various combinations, for blood pressure lowering treatment. Beta-blockers (BBs) are included among the major antihypertensive medications.

Modern Medicine – Issue 5 2023

Fluid Regulation is Vital in Hypertension Management

Fluid balance is inextricably linked with electrolyte balance, both in the intracellular (rich in K+ ions) and extracellular (rich in Na+ & Cl- ions) compartments, where trading of electrolytes is the core strategy of renal fluid regulation. Medicinal products that affect renal regulation of electrolyte excretion have a significant effect in terms of the quantity of fluid control and thus water homeostasis.

Modern Medicine – Issue 4 2023

Lipid Levels – Important Clues for Cardio and Pancreas Health

Hypertriglyceridemia (HTG), as an important component of atherogenic dyslipidaemia and a cardiovascular disease risk factor, should be carefully evaluated and managed via lifestyle modification and pharmacotherapy. Although statins form a basis of the contemporary lipid-modifying treatment, major trials support the findings that therapy with fibrates is most beneficial in patients with triglyceride levels above 204mg/dL and high-density lipoprotein cholesterol (HDL-C) below 34mg/dL.

Modern Medicine – Issue 4 2023

Add-on Fibrates’ Cardio Protection Still Evident Years On

The extended follow-up study (ACCORDION) of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, evaluated the ‘legacy effects’ of fibrate add-on therapy on mortality and major cardiovascular outcomes in patients with dyslipidaemia. Fibrate treatment during the initial trial period was associated with a legacy benefit of improved survival over a post-trial follow-up. This is a shortened version of the original article.

Modern Medicine – Issue 2 2023