CardioScripts Classic – Hypertension [Part 2]

Part 2 of the CardioScripts Classics episode on hypertension with Drs. Tracy Macaulay and Liz Wang.

0:00-1:07: Introduction

1:08-5:23: SPRINT Trial

5:23-9:14: Elderly patients with hypertension

9:15-17:50: Hypertension management in Black patients

17:51-21:57: Hypertension nuances

21:58-23:30: Closing

References:

SPRINT Trial: The SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2015;373(22):2103-16.

European Hypertension Guidelines: Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018;39(33):3021-3104.

Sulaica EM, Wollen JT, Kotter J, Macaulay TE. A Review of Hypertension Management in Black Male Patients. Mayo Clin Proc 2020;95(9):1955-1963.

Victor RG, Ravenell JE, Freeman Anne, et al. Effectiveness of a barber-based intervention for improving hypertension control in black men: the BARBER-1 study: a cluster randomized trial. Arch Intern Med 2011;171(4):342-50.

Victor RG, Lynch K, Li N, et al. A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops. N Engl J Med 2018;378(14):1291-1301.

CardioScripts Classic – Hypertension [Part 1]

Drs. Tracy Macaulay and Liz Sulaica discuss hypertension.

0:00-0:45: Introduction

0:46-2:14: Intro of Dr. Liz Sulaica

2:15-4:19: SHEP Trial

4:20-6:19: Syst-Eur Trial

6:20-11:17: ALLHAT Trial

11:18-15:59: ACCOMPLISH Trial

16:00-18:53: HCTZ vs. Chlorthalidone

18:54-22:03: JNC 8

22:04-22:35: Closing

References:

SHEP Trial: SHEP Cooperative Research Group. Prevention of Stroke by Antihypertensive Drug Treatment in Older Persons With Isolated Systolic Hypertension. JAMA 1991;265:3255-3264.

Syst-Eur Trial: Staessen JA, Fagard R, Thijs L, et al. Randomised double-blind comparison of placebo and active treatment for older persons with isolated systolic hypertension. Lancet 1997;350:757-64.

ALLHAT Trial: ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA 2002;288(23):2981-97.

ACCOMPLISH Trial: Jamerson KJ, Weber MA, Bakris GL, et al. Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients. N Engl J Med 2008; 359:2417-28.

Chlorthalidone vs HCTZ: Hripcsak G, Suchard MA, Shea S, et al. Comparison of Cardiovascular and Safety Outcomes of Chlorthalidone vs. Hydrochlorothiazide to Treat Hypertension. JAMA Int Med 2020;80(4):542-51.

JNC 8: James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311(5):507-520.

2017 ACC/AHA Hypertension Guideline: Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018;71(19):e127-e248.

Ripley TL, Brenner M, Finks S, et al. Key articles and guidelines in the management of hypertension. J Pharm Pract 2015;28(2):146-61.

Wright JT, Fine LJ, Lackland DT, et al. Evidence supporting a systolic BP goal of less than 150 mm Hg in patients aged 60 years or older: the minority view. Ann Intern Med 2014;160(7):499-503.

The ADAPTABLE Trial

Dr. Matthew Wanat and CardioScripts co-host, Dr. Liz Sulaica, discuss the ADAPTABLE trial. 

0:00-0:25: Introduction 

0:26-1:32: Introduction of Dr. Matthew Wanat

1:33-6:25: ADAPTABLE Overview 

6:26-10:23: Aspirin Dosing and Overall Thoughts 

10:24-12:06: Trial Limitations

12:07:-14:15: Literature and Guidelines for Aspirin in Primary Prevention (see additional references below)

14:16-18:11: Pragmatic Study Design

18:12-19:24: Final Thoughts 

19:25-19:57: Closing 

References: 

ADAPTABLE: Jones WS, Mulder H, Wruck LM, et al. Comparative Effectiveness of Aspirin Dosing in Cardiovascular Disease. N Engl J Med. 2021;384(21):1981-1990. doi:10.1056/NEJMoa2102137

2019 ACC/AHA Primary Prevention Guidelines: Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2019 Sep 10;140(11):e649-e650] [published correction appears in Circulation. 2020 Jan 28;141(4):e60] [published correction appears in Circulation. 2020 Apr 21;141(16):e774]. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678

ASPREE: McNeil JJ, Nelson MR, Woods RL, et al. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. N Engl J Med. 2018;379(16):1519-1528. doi:10.1056/NEJMoa1803955

ARRIVE: Gaziano JM, Brotons C, Coppolecchia R, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet. 2018;392(10152):1036-1046. doi:10.1016/S0140-6736(18)31924-X

ASCEND: ASCEND Study Collaborative Group, Bowman L, Mafham M, et al. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med. 2018;379(16):1529-1539. doi:10.1056/NEJMoa1804988

The PARADISE-MI Trial

Dr. Stephanie Dwyer Kaluzna and CardioScripts co-host, Dr. Tracy Macaulay, discuss the PARADISE-MI trial. 

0:00-0:25: Introduction 

0:26-1:19: Introduction of Dr. Stephanie Dwyer Kaluzna

1:20-6:14: PARADISE-MI Overview 

6:15-7:56: Overall Thoughts 

7:57-10:28: Use of ACE-I/ARB in MI

10:30-13:43: Background Therapy Considerations 

13:44-18:08: Applicability and Feasibility of Use

18:09-19:24: Final Thoughts 

19:25-20:02: Closing 

References: 

PARADISE-MI Trial: Design and baseline characteristics: Jering KS, Claggett B, Pfeffer MA, et al. Prospective ARNI vs. ACE inhibitor trial to DetermIne Superiority in reducing heart failure Events after Myocardial Infarction (PARADISE-MI): design and baseline characteristics [published online ahead of print, 2021 Apr 12]. Eur J Heart Fail. 2021;10.1002/ejhf.2191. doi:10.1002/ejhf.2191

AIRE Trial: Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Lancet. 1993;342(8875):821-828.

VALIANT Trial: McMurray J, Solomon S, Pieper K, et al. The effect of valsartan, captopril, or both on atherosclerotic events after acute myocardial infarction: an analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT). J Am Coll Cardiol. 2006;47(4):726-733. doi:10.1016/j.jacc.2005.09.055

EPHESUS Trial: Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction [published correction appears in N Engl J Med. 2003 May 29;348(22):2271]. N Engl J Med. 2003;348(14):1309-1321. doi:10.1056/NEJMoa030207

Timing of initiation of eplerenone in EPHESUS: Adamopoulos C, Ahmed A, Fay R, et al. Timing of eplerenone initiation and outcomes in patients with heart failure after acute myocardial infarction complicated by left ventricular systolic dysfunction: insights from the EPHESUS trial. Eur J Heart Fail. 2009;11(11):1099-1105. doi:10.1093/eurjhf/hfp136

EMPEROR-Reduced: Reign of the SGLT2 Inhibitors

Dr. Ted Berei and CardioScripts co-host, Dr. Tracy Macaulay, discuss the EMPEROR-Reduced trial. 

0:00-0:28: Introduction 

0:29-1:05: Introduction of Dr. Ted Berei 

1:06-3:40: EMPEROR-Reduced Overview 

3:41-5:08: Overall Thoughts 

5:09 -11:18: Secondary Endpoints 

11:19-19:04: Considerations for Initiation of SGLT2 Inhibitors 

19:05-21:21: Final Thoughts 

21:22-22:02: Closing 

References: 

  • McMurray, John JV, et al. “Dapagliflozin in patients with heart failure and reduced ejection fraction.” New England Journal of Medicine 381.21 (2019): 1995-2008. 
  • Packer, Milton, et al. “Cardiovascular and renal outcomes with empagliflozin in heart failure.” New England Journal of Medicine 383.15 (2020): 1413-1424. 
  • Vardeny, Orly, and Muthiah Vaduganathan. “Practical guide to prescribing sodium-glucose cotransporter 2 inhibitors for cardiologists.” JACC: Heart Failure 7.2 (2019): 169-172. 
  • Das, Sandeep R., et al. “2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes: a report of the American College of Cardiology solution set oversight committee.” Journal of the American College of Cardiology 76.9 (2020): 1117-1145. 

POPular TAVI Trial [Cohort A]

Dr. John Lindsley and CardioScripts co-host, Dr. Liz Sulaica, discuss cohort A of the POPular TAVI trial.

0:00-0:28: Introduction

0:29-1:04: Introduction of Dr. John Lindsley

1:05-6:12: Cohort A Overview

6:13-10:18: Overall Thoughts

10:19-12:30: Subclinical Valve Thrombosis

12:31-15:05: Management strategies

15:06-15:52: Final Thoughts

15:53-16:31: Closing

References:

  • POPular TAVI Trial [Cohort A]: Brouwer J, Nijenhuis VJ, Delewi RS, et al. Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation. N Engl J Med 2020; 383: 1447-57. DOI: 10.1056/NEJMoa2017815.
  • POPular TAVI Trial [Cohort B]: Nijenhuis VJ, Brouwer J, Delewi R, et al.  Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation. N Engl J Med 2020; 382:1696-1707. DOI: 10.1056/NEJMoa1915152.
  • ARTE Trial: Rodes-Cabau J, Masson J, Welsh RC, et al. Aspirin Versus Aspirin Plus Clopidogrel as Antithrombotic Treatment Following Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve: The ARTE (Aspirin Versus Aspirin + Clopidogrel Following Transcatheter Aortic Valve Implantation) Randomized Clinical Trial. JACC Cardiovasc Interv. 2017 Jul 10;10(13):1357-1365.
  • GALILEO Trial: Dangas G, Tijssen JG, Wöhrle J, et al. A Controlled Trial of Rivaroxaban after Transcatheter Aortic-Valve Replacement.
  • PARTNER Trial: Leon MB, Smith CR, Mack M, et al. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. N Engl J Med 2010; 363:1597-1607.
  • Otto CM, Kumbhani DJ, Alexander KP, et al. 2017 ACC Expert Consensus Decision Pathway for Transcatheter Aortic Valve Replacement in the Management of Adults With Aortic Stenosis: A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2017;69(10):1313-46.

The LoDoCo2 Trial

Dr. Toby Trujillo and CardioScripts co-host, Dr. Tracy Macaulay, discuss the LoDoCo2 trial.

0:00-027: Intro

0:28-1:03: Introduction of Dr. Toby Trujillo

1:04-4:10: LoDoCo2 Trial Overview

4:11-8:10: Overall Thoughts

8:11-9:49: Run-in period and tolerability

9:50-10:28: Monitoring and Infection

10:29-14:00: Fun New Game – Guess That Trial!! (hint – CURE and parallels to LoDoCo2)

14:01-14:59: Polypharmacy and When Colchicine??

15:00-15:35: Final Thoughts

15:36-16:09: Closing

References:

LoDoCo2 Trial: Nidorf SM, Fiolet ATL, Mosterd A, et al. Colchicine in Patients with Chronic Coronary Disease. N Engl J Med 2020; 383: 1838-47.

COLCOT Trial: Tardif J, Kouz S, Waters DD, et al. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. N Engl J Med 2019; 381: 2497-505.

CANTOS Trial: Ridker PM, Everett BM, Thuren T, et al. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. N Engl J Med 2017; 377: 1119-31.

CLEAR SYNERGY Trial: NCT03048825. https://clinicaltrials.gov/ct2/show/NCT03048825

CURE Trial: Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345(7): 494-502.

The EVAPORATE Trial

Dr. Dave Dixon and CardioScripts co-host, Dr. Liz Sulaica, discuss the EVAPORATE trial and where icosapent ethyl fits.

0:00-0:27: Intro

0:28-1:09: Introduction of Dr. Dave Dixon

1:10-4:38: EVAPORATE Overview

4:39-6:12: Overall thoughts about EVAPORATE

6:13-9:23: Trial limitations

9:24-11:55: Isocapent ethyl in practice – involve the patient in decision-making!

11:56-14:31: How has practice changed since REDUCE-IT?

14:32-15:31: Final thoughts

15:32-16:09: Closing

References

  • Budoff MJ, Bhatt DL, Kinninger A, et al. Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: final results of the EVAPORATE trial. Eur Heart J 2020; doi: 10.1093/eurheartj/ehaa652.
  • Bhatt DL, Steg PG, Miller M , et al. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med 2019; 380:11-22.
  • Budoff MJ, Muhlestein JB, Bhatt DL, et al. Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: a prospective, placebo-controlled randomized trial (EVAPORATE): interim results. Cadiovasc Res 2020; doi: 10.1093/cvr/cvaa184.

Digging into Dig[oxin]

Dr. Robert DiDomenico and CardioScripts co-host, Dr. Tracy Macaulay, discuss the RATE AF trial and all things digoxin: its past role, therapeutic levels, and current and future state!

0:00-0:32 Intro

0:28-1:02: Welcome back and Introduction of Dr. DiDomenico

1:03-4:33: Overview of the RATE-AF trial as presented at ESC 2020 and based on published trial rationale.

4:34-6:40: How did RATE AF confirm or add to our understanding of digoxin use in Atrial Fibrillation

6:41-9:36:  If we use digoxin, what levels are you targeting and what goals are you setting?

9:37-11:50: Digoxin in HFpEF patients

11:51-16:26: Digoxin and Mortality

16:27-17:28: Final thoughts

17:29-18:04: Closing

References:

  • Rate Control Therapy Evaluation in Permanent Atrial Fibrillation.  Results presented by Dr. Dipak Kotecha at the European Society of Cardiology Virtual Congress, August 29, 2020.
  • Kotecha D, Calvert M, Deeks JJ, et al.  A review of rate control in atrial fibrillation, and the rationale and protocol for RATE-AF trial.  BMJ Open 2017;7:e015099.
  • Ahmed A, Rich MW, Fleg JL et al. Effects of digoxin on morbidity and mortality in diastolic heart failure: the ancillary digitalis investigation group trial. Circulation 2006;11397-403.
  • Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997;336:525–533. 11.
  • Ahmed A, Rich MW, Love TE, Lloyd-Jones DM, Aban IB, Colucci WS, Adams KF, Gheorghiade M. Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. Eur Heart J. 2006;27:178–186. 12.
  • Massie BM, Abdalla I. Heart failure in patients with preserved left ventricular systolic function: do digitalis glycosides have a role? Prog Cardiovasc Dis. 1998;40:357–369.
  • Adams KF Jr, Patterson JH, Gattis WA, et al. Relationship of serum digoxin concentration to mortality and morbidity in women in the digitalis investigation group trial: a retrospective analysis.  J Am Coll Cardiol. 2005 Aug 2;46(3):497-504. 
  • Vamos M, Erath JW, Benz AP, et al. Meta-analysis of effects of digoxin on survival in patients with atrial fibrillation or heart failure: An update. Am J Cardiolo 2019;123:69-74.
  • DiDomenico RJ, Bress AP, NA-Thalang K, et al. Use of a simplified nomogram to individualize digoxin dosing versus standard dosing practice in patients with heart failure. Pharmacotherapy 2014; 34:1121-31.
  • Bauman JL, DiDomenico RJ, Viana M, Fitch M. A method of determining the dose of digoxin for heart failure in the modern era.  Arch Intern Med. 2006 Dec 11-25;166(22):2539-45. 
  • Singh S, Moore H, Karasik PE, et al. Digoxin initiation and outcomes in patients with heart failure (HFrEF and HFpEF) and atrial fibrillation. Am J Med 2002:S0002-9343(20)30528-3.