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- Ageno, Walter, et al.
(author)
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Managing reversal of direct oral anticoagulants in emergency situations Anticoagulation Education Task Force White Paper
- 2016
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In: Thrombosis and Haemostasis. - : SCHATTAUER GMBH-VERLAG MEDIZIN NATURWISSENSCHAFTEN. - 0340-6245 .- 2567-689X. ; 116:6, s. 1003-1010
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Journal article (peer-reviewed)abstract
- Anticoagulation is the cornerstone of prevention and treatment of venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation (AF). However, the mechanisms by which anticoagulants confer therapeutic benefit also increase the risk of bleeding. As such, reversal strategies are critical. Until recently, the direct oral anticoagulants (DOACs) dabigatran, rivaroxaban, apixaban, and edoxaban lacked a specific reversal agent. This report is based on findings from the Anticoagulation Education Task Force, which brought together patient groups and professionals representing different medical specialties with an interest in patient safety and expertise in AF, VTE, stroke, anticoagulation, and reversal agents, to discuss the current status of anticoagulation reversal and fundamental changes in management of bleeding associated with DOACs occasioned by the approval of idarucizumab, a specific reversal agent for dabigatran, as well as recent clinical data on specific reversal agents for factor Xa inhibitors. Recommendations are given for when there is a definite need for a reversal agent (e.g. in cases of life-threatening bleeding, bleeding into a closed space or organ, persistent bleeding despite local haemostatic measures, and need for urgent interventions and/or interventions that carry a high risk for bleeding), when reversal agents may be helpful, and when a reversal agent is generally not needed. Key stakeholders who require 24-7/around-the-clock access to these agents vary among hospitals; however, from a practical perspective the emergency department is recommended as an appropriate location for these agents. Clearly, the advent of new agents requires standardised protocols for treating bleeding on an institutional level.
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- Kotsis, Vasilios, et al.
(author)
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Obesity and cardiovascular risk : A call for action from the European Society of Hypertension Working Group of Obesity, Diabetes and the High-risk Patient and European Association for the Study of Obesity: Part A: Mechanisms of obesity induced hypertension, diabetes and dyslipidemia and practice guidelines for treatment
- 2018
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In: Journal of Hypertension. - 0263-6352. ; 36:7, s. 1427-1440
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Research review (peer-reviewed)abstract
- Obesity is a key factor for cardiovascular diseases and complications. Obesity is associated with hypertension, dyslipidemia and type II diabetes, which are the major predictors of cardiovascular disease in the future. It predisposes for atrial fibrillation, heart failure, sudden cardiac death, renal disease and ischemic stroke that are the main causes of cardiovascular hospitalization and mortality. As obesity and the cardiovascular effects on the vessels and the heart start early in life, even from childhood, it is important for health policies to prevent obesity very early before the disease manifestation emerge. Key roles in the prevention are strategies to increase physical exercise, reduce body weight and to prevent or treat hypertension, lipids disorders and diabetes earlier and efficiently to prevent cardiovascular complications. Epidemiology and mechanisms of obesity-induced hypertension, diabetes and dyslipidemia will be reviewed and the role of lifestyle modification and treatment strategies in obesity will be updated and analyzed. The best treatment options for people with obesity, hypertension, diabetes and dyslipidemia will discussed.
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- Kotsis, Vasilios, et al.
(author)
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Obesity and cardiovascular risk : A call for action from the European Society of Hypertension Working Group of Obesity, Diabetes and the High-risk Patient and European Association for the Study of Obesity: Part B: Obesity-induced cardiovascular disease, early prevention strategies and future research directions
- 2018
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In: Journal of Hypertension. - 0263-6352. ; 36:7, s. 1441-1455
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Research review (peer-reviewed)abstract
- Obesity predisposes for atrial fibrillation, heart failure, sudden cardiac death, renal disease and ischemic stroke, which are the main causes of cardiovascular hospitalization and mortality. As obesity and the cardiovascular effects on the vessels and the heart start early in life, even from childhood, it is important for health policies to prevent obesity very early before the disease manifestation emerge. Key roles in the prevention are strategies to increase physical exercise, reduce body weight and to prevent or treat hypertension, lipids disorders and diabetes earlier and efficiently to prevent cardiovascular complications.
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- Kreutz, Reinhold, et al.
(author)
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Beta-blocker bashing and downgrading in hypertension management : A fashionable trend representing a matter of concern
- 2024
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In: Journal of Hypertension. - : Wolters Kluwer. - 0263-6352 .- 1473-5598. ; 42:6, s. 966-967
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Journal article (peer-reviewed)abstract
- In their commentary, Shantsila et al.[1] while discussing some relevant issues of the 2023 Guidelines for the Management of Hypertension of the European Society of Hypertension (ESH) [2], for example, the length of the text and the involvement of only a few primary care physicians, they largely focus on the discussion on beta-blockers. The authors conclude that ‘the 2023 ESH Guidelines still argue in favour of beta-blockers that their clinical inferiority was simply to lesser blood pressure (BP) reduction rather than class effect’. However, this is an oversimplification that does not reflect the numerous arguments and facts that support the overall rationale of the 2023 ESH Guidelines for the recommended use of beta-blockers in the management of hypertension [2]. Taken together with other similar comments [3], it appears that it has become fashionable to down-grade beta-blockers and to dismiss the points already put forward in the 2023 ESH guidelines [2] and in previous publications revisiting beta-blocker benefits in detail [4,5]. Against this background, we use this opportunity to emphasize on key aspects of the beta-blocker discussion in brief. For a more comprehensive review of the literature, we refer to a very recent publication by us regarding the role of beta-blocker in hypertension [6].
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- Mancia, Giuseppe, et al.
(author)
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Rationale for the inclusion of β-blockers among major antihypertensive drugs in the 2023 European society of hypertension guidelines
- 2024
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In: Hypertension. - : Wolters Kluwer. - 0194-911X .- 1524-4563. ; 81:5, s. 1021-1030
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Research review (peer-reviewed)abstract
- We address the reasons why, unlike other guidelines, in the 2023 guidelines of the European Society of Hypertension β-blockers (BBs) have been regarded as major drugs for the treatment of hypertension, at the same level as diuretics, calcium channel blockers, and blockers of the renin-angiotensin system. We argue that BBs, (1) reduce blood pressure (the main factor responsible for treatment-related protection) not less than other drugs, (2) reduce pooled cardiovascular outcomes and mortality in placebo-controlled trials, in which there has also been a sizeable reduction of all major cause-specific cardiovascular outcomes, (3) have been associated with a lower global cardiovascular protection in 2 but not in several other comparison trials, in which the protective effect of BBs versus the other major drugs has been similar or even greater, with a slightly smaller or no difference of global benefit in large trial meta-analyses and a similar protective effect when comparisons extend to BBs in combination versus other drug combinations. We mention the large number of cardiac and other comorbidities for which BBs are elective drugs, and we express criticism against the exclusion of BBs because of their lower protective effect against stroke in comparison trials, because, for still uncertain reasons, differences in protection against cause-specific events (stroke, heart failure, and coronary disease) have been reported for other major drugs. These partial data cannot replace global benefits as the main deciding factor for drug choice, also because in the general hypertensive population whether and which type of event might occur is unknown.
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