European heart journal
-
European heart journal · Jan 2021
Meta AnalysisShort dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy vs. prolonged dual antiplatelet therapy after percutaneous coronary intervention with second-generation drug-eluting stents: a systematic review and meta-analysis of randomized clinical trials.
After percutaneous coronary intervention (PCI) with second-generation drug-eluting stent (DES), whether short dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy (SAPT) with a P2Y12 receptor inhibitor confers benefits compared with prolonged DAPT is unclear. ⋯ After second-generation DES implantation, 1-3 months of DAPT followed by P2Y12 inhibitor SAPT is associated with lower major bleeding and similar stent thrombosis, all-cause death, myocardial infarction, and stroke compared with prolonged DAPT. Whether P2Y12 inhibitor SAPT is preferable to aspirin SAPT needs further investigation.
-
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