European heart journal
-
European heart journal · Dec 2020
Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial.
Relevance?
Although anti-hypertension therapies are the domain of primary care physicians, because of their widespread use they are common medications for hospital patients. Previous studies have shown that nocturnal anti-hypertensive dosing improves BP control, although have not addressed major cardiac outcomes.
This 10-year, large, multicenter RCT demonstrates benefit of evening medication dosing that has implications perioperatively.
The study...
The Hygia Project randomised 19,084 patients (x̄=61y 56%♂ 34%♀) to take their anti-hypertensive medications (≥1) either at bed-time or on awakening. Patients were followed for a median 6.3 years, routinely using 48h ambulatory BP monitoring at each follow-up review.
They found that...
Patients taking anti-hypertensives in the evening experienced better BP control and 45% lower rates of major cardiovascular outcomes, including CVD death, infarct, coronary revascularisation, heart failure and stroke.
Interestingly the progressive decline in sleeping SBP during the study was the strongest predictor of cardiovascular risk, stronger than traditional risk markers such as age, gender, DM, CKD, cholesterol or even smoking!
Practice changing?
This is a significant finding from a large, high-quality study. It confirms the benefits of nocturnal dosing, also likely (though unconfirmed) to have intraoperative and perioperative benefits compared with morning dosing.
summary -
European heart journal · Dec 2020
A practical risk score for early prediction of neurological outcome after out-of-hospital cardiac arrest: MIRACLE2.
The purpose of this study was to develop a practical risk score to predict poor neurological outcome after out-of-hospital cardiac arrest (OOHCA) for use on arrival to a Heart Attack Centre. ⋯ The MIRACLE2 is a practical risk score for early accurate prediction of poor neurological outcome after OOHCA, which has been developed for simplicity of use on admission.