The American journal of medicine
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Randomized Controlled Trial Multicenter Study
Antihypertensive efficacy of hydrochlorothiazide vs chlorthalidone combined with azilsartan medoxomil.
Chlorthalidone has proven efficacy to reduce cardiovascular morbidity and mortality, yet it is infrequently used in practice. This study provides a direct comparison of chlorthalidone with hydrochlorothiazide, each combined with the angiotensin receptor blocker azilsartan medoxomil, on blood pressure reduction and control rates. ⋯ Chlorthalidone combined with azilsartan medoxomil provides better blood pressure reduction and a higher likelihood of achieving blood pressure control than hydrochlorothiazide combined with azilsartan medoxomil. This benefit occurred without a difference in safety measurements.
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Chronic obstructive pulmonary disease (COPD) is recognized by the Global Initiative for Chronic Obstructive Lung Disease guidelines as an inflammatory disease state, and treatment rationales are provided accordingly. However, not all physicians follow or are even aware of these guidelines. Research has shown that COPD inflammation involves multiple inflammatory cells and mediators and the underlying pathology differs from asthma inflammation. ⋯ The clinical and systemic consequences believed to result from the chronic inflammation observed in COPD suggest that inflammation intensity is a key factor in COPD and exacerbation severity and frequency. Although inhaled corticosteroids are commonly used and are essential in asthma management, their efficacy in COPD is limited, with only a modest effect at reducing exacerbations. The importance of inflammation in COPD needs to be better understood by clinicians, and the differences in inflammation in COPD versus asthma should be considered carefully to optimize the use of anti-inflammatory agents.
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Increasingly, opioids are used to treat chronic noncancer pain. While opioids are well recognized for their effectiveness in treating acute pain, the evidence supporting the benefits for the treatment of chronic pain is less well established. Improvement of both pain and function should be considered goals of therapy. ⋯ Risk factors for poor outcomes with opioid therapy are identified, and include preexisting mental illness and dose prescribed. Recommended strategies to more safely use opioids are discussed, including tools for identifying high-risk patients. The evidence supporting the use of treatment agreements and urine drug testing to reduce the effects of adverse outcomes is limited.
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Heparin is commonly used for venous thromboembolism prophylaxis; however, the incidence of acquired thrombocytopenia in this setting has not been well described. ⋯ Thrombocytopenia occurs frequently in patients on heparin venous thromboembolism prophylaxis, yet its diagnosis has minimal impact on downstream management. The development of thrombocytopenia is associated with increased bleeding risk.
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Aspirin, by virtue of inhibition of platelet hemostatic function, is withheld before many invasive procedures because of the bleeding risk. American Society of Gastrointestinal Endoscopy guidelines acknowledge the paucity of "high quality data" to make recommendations regarding the use of aspirin (ASA) and nonsteroidal anti-inflammatory drugs (NSAIDs) before endoscopic procedures. Yet the majority of endoscopists hold ASA/NSAIDs before polypectomy. ⋯ In this large study, use of ASA or NSAIDs did not increase the risk of postpolypectomy bleeding. Cessation of ASA/NSAIDs before colonoscopy/polypectomy is therefore unnecessary.