duminică, 5 august 2012
joi, 15 decembrie 2011
Using A Restrictive Approach In Post-Surgical Blood Transfusions Is Safe And Saves Blood
Also Included In: Blood / Hematology
Article Date: 15 Dec 2011 - 2:00 PST
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New research published online in advance of print in the New England Journal of Medicine could refine the way that post-operative patients are cared for while preserving blood supply levels, an essential resource that is difficult to maintain at necessary quantities throughout the year. The study, led by researchers at UMDNJ-Robert Wood Johnson Medical School, shows that using a liberal blood transfusion strategy in post-operative hip-surgery patients did not appear to improve patients' recoveries or reduce the rate of death, suggesting therefore, that utilizing a restrictive transfusion approach would be appropriate patient care and conserve blood.
"The need for, and the quantity of, transfusion of red blood cells in post-operative patients is controversial, but has not previously been evaluated in a large study," said Jeffrey L. Carson, MD, the Richard C. Reynolds Professor of Medicine and study chair of the Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair, known as the FOCUS trial. "Our research shows that using a more restrictive transfusion approach could become the standard of care for post-orthopedic surgical, high-risk patients with underlying cardiovascular disease and save blood a precious resource."
The study examined more than 2,000 high-risk patients, with a mean age of 82, with underlying cardiovascular disease or risk factors, and hemoglobin levels below 10 grams per deciliter, after hip surgery. Hemoglobin (Hb or Hgb) is the main component of red blood cells that carries oxygen throughout the body and is normally greater than 12 to 13 grams per deciliter. Patients commonly have a low hemoglobin level after surgery that results from bleeding and often receive red blood cell transfusion as treatment. However, the optimal level of hemoglobin at which blood transfusion should be administered has been unknown.
"This clinical trial is unique in that all patients were considered very high risk due to age and prior history of cardiovascular disease, including myocardial infarction (heart attack), or risk factors for heart disease," said Dr. Carson.
Patients were randomly assigned a liberal transfusion strategy (transfusion if hemoglobin was less than 10 grams per deciliter) or a restrictive transfusion strategy (transfusion if hemoglobin was less than 8 grams per deciliter). Patients in the restrictive group also received a transfusion if they exhibited symptoms of anemia including chest pain, congestive heart failure or unexplained excessive heart rate. At 30 and 60 days post-surgery, there was no difference between the groups in the patients' inability to walk without assistance nor was there a significant difference in the rate of death or heart attacks. Because the liberal transfusion strategy did not provide a benefit to patient outcomes as compared with the restrictive strategy, the study suggests that less blood transfusion may be appropriate and does not detrimentally affect patients' recovery after surgery.
The FOCUS Trial was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. The study results, "Liberal or Restrictive Transfusion in High-risk Patients after Hip Surgery", were published online today. Dr. Carson's team of researchers at Robert Wood Johnson Medical School included: Helaine Noveck, MPH, deputy director, Clinical Coordinating Center; George G. Rhoads, MD, MPH, interim dean and professor at UMDNJ-School of Public Health; and Karen Dragert, RN, lead research nurse. He was assisted by investigators at the University of Maryland School of Medicine (Michael L. Terrin, MD, MPH, principal investigator, Data Coordinating Center, and Jay Magaziner, PhD, MSHyg) and from 47 hospitals in the United States and Canada.
Article adapted by Medical News Today from original press release. Source: Springer Science+Business MediaVisit our transplants / organ donations section for the latest news on this subject. Springer Science+Business Media Please use one of the following formats to cite this article in your essay, paper or report:
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marți, 13 decembrie 2011
Therapy Improves Stem Cell Engraftment In Umbilical Cord Blood Transplant Recipients
Also Included In: Transplants / Organ Donations
Article Date: 13 Dec 2011 - 1:00 PST
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A therapy involving a natural compound may improve the ability of stem cells from umbilical cord blood to engraft in patients receiving a stem cell transplant for cancer or other diseases, a phase I clinical trial led by Dana-Farber Cancer Institute scientists indicates.
Details of the trial (abstract 653), which involved 12 patients who underwent reduced-intensity chemotherapy and then received a transplant of cord blood stem cells treated with the compound FT1050, will be presented at the American Society of Hematology's 2011 annual meeting on Monday, Dec. 12, at 2:45 p.m. PST.
FT1050-treated blood-forming stem cells are being tested as a possible solution to one of the major shortcomings of transplants involving stem cells from umbilical cord blood: the relatively small number of stem cells infused in such procedures often take longer to engraft or take root in patients than do the more numerous stem cells involved in transplants from adult donors. The delay can leave patients susceptible to dangerous infections and other complications.
"There is a significant need to improve the speed and quality of engraftment of cord-derived stem cells," says trial leader Corey Cutler, MD, MPH, of Dana-Farber and Brigham and Women's Hospital. "FT1050 has shown the ability in preclinical research to activate hematopoetic [blood-forming] stem cells so they engraft more quickly and with a higher degree of success."
Umbilical cord stem cell transplants are an option for patients who do not have a closely-matched adult donor. Because the current pool of potential donors is smaller for non-Caucasians than for Caucasians, members of ethnic minorities tend to receive transplants from cord blood at a higher rate than Caucasians do.
The goal of the phase I trial was to assess the safety of FT1050-treated cord blood cells in adult patients receiving umbilical cord blood stem cell transplants, and determine if the treated cells accelerate engraftment. In the 12 patients who participated in the trial, engraftment occurred approximately three to four days faster than happens with standard cord blood cells. Levels of white blood cells known as neutrophils returned to normal in the patients after a median of 17.5 days, similar to the rate in standard stem cell transplants. Side effects of the FT1050-treated cord blood cells were minimal. In none of the study patients did the stem cells fail to engraft.
The phase I trial was sponsored by Fate Therapeutics, Inc., of San Diego, Calif., which is developing ProHema, a biologic product consisting of hematopoietic stem cells treated with FT1050 for patients undergoing stem cell transplantation. FT1050 was identified by Leonard Zon, MD, a hematologist and director of the Stem Cell Program at Children's Hospital Boston, using chemical screens conducted in zebrafish, and is the first potential therapeutic derived from a zebrafish model to make into clinical trials.
"We're encouraged by the results of this study for patients receiving umbilical cord stem cell transplants after reduced-intensity chemotherapy treatment," Cutler says. "Further studies are planned to test FT1050-treated hematopoietic stem cells in a larger group of these patients."
Article adapted by Medical News Today from original press release. Source: Dana-Farber Cancer InstituteVisit our stem cell research section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:
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Blood Pressure Monitoring: Room For Improvement
Article Date: 13 Dec 2011 - 0:00 PST
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Inaccurate blood pressure measurements due to faulty technique impact hypertension treatment decisions
Because some clinicians fail to stick to official recommendations for blood pressure monitoring, a number of patients are misclassified, which could have an impact on decisions about their treatment. According to Gretchen Ray and colleagues, from the University of New Mexico College of Pharmacy, when routine blood pressure monitoring in clinics is compared with measurements based on the latest guidelines, 93 percent of patients have different blood pressure readings. The findings appear online in the Journal of General Internal Medicine, published by Springer.
In 2005, the American Heart Association (AHA) released updated recommendations for blood pressure monitoring, to ensure accurate and consistent blood pressure measurements. Numerous factors including body position, arm position, inter-arm differences, cuff size and cuff placement can affect the reading.
Ray and colleagues compared the blood pressure readings of 40 patients obtained by the traditional method routinely used in clinics, as well as by the AHA-recommended method. Based on these two readings for each patient, the researchers produced two medical profile summaries (one for each technique used), covering past medical history, medication list, drug allergies, vital signs, presence or absence of pain, physical examination and laboratory findings, as well as the last two blood pressure readings. These profiles were reviewed by three physicians who provided hypothetical hypertension treatment recommendations.
Ray and colleagues found that overall, individual blood pressure measurements varied greatly between the two methods. As many as 93 percent of patients had a significant blood pressure difference between the two readings (either over 5 mmHg systolic or over 2 mmHg diastolic), with implications for potential cardiovascular complications.
The researchers observed multiple technical errors during the method that most likely accounted for differences between the blood pressure readings. Out of ten possible errors (as defined by the AHA), the average number of errors per patient during the traditional assessment was four. The most common technical error was the absence of measurements on both arms, presumably to save time during measurement. The time to measure blood pressure using the AHA method was over eight minutes (due to the required five minute resting period between arm measurements) versus two minutes using the traditional method.
According to the hypertension medication treatment decisions provided by the three physicians, 45 percent of patients would have received different treatments based on their two blood pressure measurements.
Ray concludes: "Inaccurate blood pressure assessment is common and may impact hypertension treatment. Clinic staff need to be educated on the AHA recommendations for accurate blood pressure measurement, and encouraged to follow them in order to obtain a more accurate reading. More accurate blood pressure measurement could result in improved hypertension management decisions."
Article adapted by Medical News Today from original press release. Source: Springer Science+Business MediaVisit our hypertension section for the latest news on this subject. Springer Science+Business Media Please use one of the following formats to cite this article in your essay, paper or report:
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13 Dec. 2011.
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Erythropoietin May Pose A Risk To Blood Vessels In The Brain And Body
Also Included In: Neurology / Neuroscience; Sports Medicine / Fitness
Article Date: 13 Dec 2011 - 0:00 PST
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Erythropoietin or EPO might be considered a "performance enhancing" substance for athletes, but new research published online in /i>The FASEB Journal shows that these enhancements come at a high cost - increased risk of vascular problems in the brain. According to the study, short- or long-term use of EPO raises blood pressure by constricting arteries, which reduces the flow of blood to the brain. This finding also contradicts earlier evidence suggesting that EPO may be a viable early treatment for stroke victims.
"The new findings of this study urge to scrutinize present indications for EPO, and so help to better delineate positive versus adversary health effects of EPO for each patient," said Peter Rasmussen, Ph.D., a researcher involved in the work from the Zurich Center for Integrative Human Physiology at the University of Zurich in Switzerland. "Future research should aim at developing an EPO-based agent for treatment that does not have a negative effect on the blood vessels of the brain."
To make this discovery, Rasmussen and colleagues evaluated the effects of acute high doses of EPO for three days and chronic low doses of EPO for 13 weeks in two groups of healthy males. Responsiveness of brain vessels during rest and during bike-riding exercise, with and without hypoxia, was examined. Blood vessels were also analyzed using ultrasound measurements and by measuring how much oxygen reached the brain. They found that prolonged EPO administration increased hematocrit, while acute administration did not. They also found that both groups had increases in blood vessel constriction and higher blood pressure.
"EPO is used by doctors to increase red blood cells in sick people who can't make enough of them: it's called honest medicine. When EPO is used by healthy bikers and runners to boost their performance, it's called cheating. Now we know that folks who use EPO covertly are cheating not only the time-clock, but themselves," said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. "Not only is EPO likely unsafe in healthy athletes, but there are many other ways to build up stamina without drugs."
Article adapted by Medical News Today from original press release. Click 'references' tab above for source.Visit our vascular section for the latest news on this subject. Details: Peter Rasmussen, Yu-Sok Kim, Rikke Krogh-Madsen, Carsten Lundby, Niels V. Olsen, Niels H. Secher, and Johannes J. van Lieshout. Both acute and prolonged administration of EPO reduce cerebral and systemic vascular conductance in humans. FASEB J. December 9, 2011; doi:10.1096/fj.11-193508; http://www.fasebj.org/content/early/2011/12/08/fj.11-193508.abstract
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13 Dec. 2011.
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Outpatients Experience The Most Cancer-Related Blood Clots
Also Included In: Vascular; Cancer / Oncology
Article Date: 13 Dec 2011 - 3:00 PST
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In a study of nearly 18,000 cancer patients, University of Rochester Medical Center researchers found that when blood clots develop - a well-known and serious complication of cancer treatment - 78 percent of the time they occur when a person is out of the hospital, at home or elsewhere, while on chemotherapy.
This data is striking because, until now, outpatients had not been systematically studied and previous data gathered on the incidence of blood clots was mostly from hospitalized patients, who tend to be sicker. However, with a shift toward outpatient cancer treatment, future efforts to prevent blood clots should focus on helping patients to avoid complications so they can continue to live fully, by working, raising children, and exercising, during cancer care, said Alok Khorana, M.D., associate professor in the James P. Wilmot Cancer Center at URMC, and an international authority on venous thromboembolism or VTE.
"One in five patients develops blood clots after a cancer diagnosis and we believe that number is rising," Khorana said. "The Surgeon General recently issued a Call to Action to reduce VTE. At this point public health efforts have focused on inpatient prophylaxis. These new data suggest that to reduce the burden of VTE in cancer patients, prevention efforts will have to shift to the outpatient arena as well."
The cost of care for patient with blood clots was twice as high compared to patients who did not have that complication, Khorana also reported.
Khorana was invited to present his data at the 2011 ASH (American Society of Hematology) annual meeting in San Diego, attended by approximately 20,000 physicians and scientists. The scientific abstracts with the highest impact, including Khorana's, were selected for platform talks.
Khorana and his research team conducted a retrospective, observational study between 2005 and 2009 from healthcare claims databases, which they believe is the largest population study of this kind. The databases provided both inpatient and outpatient information. Of the 17, 784 cancer patients identified, 5.6 percent developed blood clots, the study said. Of those who suffered from the complication, 21 percent had recently been hospitalized but 78.3 percent were being treated on an outpatient basis. The medical term venous thromboembolism is a mass of red blood cells, clotting proteins and platelets that block the normal flow of blood. Clots form most often in the legs, lungs, or abdomen, and are life-threatening if not treated.
Cancer patients are more prone to blood clots for many reasons: the malignancy itself can secrete proteins associated with blood clots; several treatments (including surgery, chemotherapy, and hormonal therapy) raise the clot risk; decreased mobility due to active disease or hospitalization; a genetic predisposition; or having other health problems, such as infections, obesity, anemia, and lung disorders. And once a blood clot occurs, a cancer patient is much more likely to have other clots later.
"Ongoing public health issues that we must address are how to educate patients on the importance of blood clot prevention, and improving compliance to preventive treatment," he said. Patients should immediately report to their physicians any unusual symptoms such as swelling or redness in limbs, or shortness of breath, even if they are otherwise feeling well.
Article adapted by Medical News Today from original press release. Click 'references' tab above for source.Visit our blood / hematology section for the latest news on this subject. For years Khorana and colleagues at URMC have been at the forefront of studying cancer-related blood clots, which is the second leading cause of death in this population.
The Rochester group published a risk model in the journal, Blood, and based partly on that article the American Society of Clinical Oncology in 2007 issued its first set of guidelines for clinicians for the prevention of blood clots in cancer patients. Chief collaborators include Charles W. Francis, M.D., professor of Medicine in Hematology/Oncology at the James P. Wilmot Cancer Center, and Mark B. Taubman, M.D., a cardiologist, researcher, and dean of the UR School of Medicine and Dentistry.
Disclosure: Khorana is a consultant for and receives cancer-related research funding from several drug companies, including Roche/Genentech, Eisai Co., Johnson and Johnson, Bristol Myers-Squibb, Boehringer Ingelheim, Leo Pharma, Sanofi-Aventis, Bayer, and Daiichi-Sankyo. Sanofi-Aventis funded this study.
University of Rochester Medical Center Please use one of the following formats to cite this article in your essay, paper or report:
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13 Dec. 2011.
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luni, 12 decembrie 2011
Blood Pressure Medicines Reduce Stroke Risk In People With Prehypertension
Also Included In: Stroke
Article Date: 12 Dec 2011 - 0:00 PST
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People with prehypertension had a lower risk of stroke when they took blood pressure-lowering medicines, according to research reported in Stroke: Journal of the American Heart Association.
Prehypertension, which affects more than 50 million adults in the United States, is blood pressure ranging between 120/80 mm Hg and 139/89 mm Hg. Hypertension is 140/90 mm Hg or higher.
"Our study pertains to people with pre-hypertensive blood pressure levels and shows that the excess risk of stroke associated with these high-normal readings (top number 120-140) can be altered by taking blood pressure pills," said Ilke Sipahi, M.D., lead author of the study and associate director of Heart Failure and Transplantation at the Harrington-McLaughlin Heart and Vascular Institute in Cleveland, Ohio.
In a meta-analysis of 16 studies, researchers examined data that compared anti-hypertensive drugs against placebo in 70,664 people with average baseline blood pressure levels within the pre-hypertensive range. The researchers found: Patients taking blood pressure-lowering medicines had a 22 percent lower risk of stroke compared to those taking a placebo. This effect was observed across all classes of anti-hypertensive drugs studied. No significant reduction in the risk of heart attack occurred, but there was a trend toward lower cardiovascular death in patients taking blood pressure medications compared to those on placebo. To prevent one stroke in the study population, 169 people had to be treated with a blood pressure-lowering medication for an average 4.3 years. American Heart Association treatment guidelines call for lifestyle changes, not medications, to reduce blood pressure in people with prehypertension. Those lifestyle changes include weight loss, physical activity, a diet rich in fruit and vegetables and low in salt and fat, and keeping alcohol consumption moderate (no more than two drinks per day for men and no more than one drink per day for women).
"We do not think that giving blood pressure medicine instead of implementing the lifestyle changes is the way to go," Sipahi said. "However, the clear-cut reduction in the risk of stroke with blood pressure pills is important and may be complementary to lifestyle changes."
The cost of long-term therapy and the risks associated with blood pressure medicines need to be discussed extensively within the medical community before undertaking guideline changes, Sipahi said.
Co-authors are: Aparna Swaminathan, fourth-year medical student; Viswanath Natesan, M.D.; Sara M. Debanne, Ph.D.; Daniel I. Simon, M.D.; and James C. Fang, M.D. Author disclosures are on the manuscript.
Article adapted by Medical News Today from original press release. Click 'references' tab above for source.Visit our hypertension section for the latest news on this subject. Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.
American Heart Association
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duminică, 11 decembrie 2011
Recognizing Blood Poisoning Quickly
Article Date: 10 Dec 2011 - 0:00 PST
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Speed can save lives especially in the case of ?blood poisoning. The more quickly and directly doctors recognize and treat ?sepsis, the greater the patient's chances of survival. With the help of a new ?biochip, physicians will now be able to analyze blood within their own ?practice.
Is the patient suffering from blood poisoning? To answer this question, the ?doctor draws a blood sample and sends it to a central laboratory for testing. ?This takes up valuable time, which could cost the patient his life. In future, ?physicians will be able to analyze blood there and then and have the results ?within twenty minutes.
This is made possible by a biochip, developed by ?scientists at the Fraunhofer Institute for Physical Measurement Techniques IPM ?in Freiburg. "To analyze the biochip we have also designed a fully automatic ?device to carry out all the examination steps," explains Dr. Albrecht ?Brandenburg, group manager at the IPM. "All the doctor has to do is place the ?sample in the apparatus and wait for the results."??Meanwhile, within the ?device there's plenty going on: it starts by preparing the blood sample. Red ?blood cells are separated from the blood and the plasma that remains is guided ?onto the biochip.
When patients are suffering from sepsis, their immune system ?reacts by producing certain proteins. The biochip uses these in its diagnosis: ?there are antibodies positioned on the chip which fit these proteins like a key ?fits a lock. If the proteins are present in the blood, the antibodies fish them ?out of the fluid and bind them to the chip. But how does the apparatus know if ?proteins have been caught? "The chip is rinsed with a solution containing the ?appropriate antibodies, which have in turn been marked with a fluorescent dye," ?explains IPM scientist Dr. Manuel Kemmler. "These bind to the proteins meaning ?antibodies, protein and marked antibodies are all firmly linked to each other ?and to the chip's surface. When the chip is illuminated, the dye lights up."
The ?apparatus sees lots of little illuminated dots that show the protein was in the ?blood. If the patient is healthy, however, the chip remains dark.??The researchers can even test for different proteins at the same time in one cycle. ?This is done by placing various different catcher molecules on the chip, to ?which specific molecules in the blood attach themselves. A cunning selection of ?proven protein markers allows the scientists to obtain additional important ?information about the severity and cause of the illness.
Together with colleagues from a university hospital, the researchers have already successfully ?tested prototypes of the device and biochip. Each biochip can only be used once so they have to be affordable. "We predict that in the long run, with ?production on a large enough scale, each chip will cost no more than one euro," ?says Brandenburg. There are various possible applications: other conditions such ?as heart attacks or cancers can also be investigated this way. What's more, the ?chip facilitates doping and urine testing as well as the quality assessment of ?foodstuffs.
Article adapted by Medical News Today from original press release. Source: Fraunhofer-GesellschaftVisit our blood / hematology section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:
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Similar Blood Pressure Drugs Could Have Different Impacts On Dialysis Patients' Heart Health
Also Included In: Cardiovascular / Cardiology; Hypertension; Urology / Nephrology
Article Date: 11 Dec 2011 - 0:00 PST
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Two seemingly similar blood pressure - lowering drugs have different effects on the heart health of dialysis patients, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The results indicate that certain dialysis patients may benefit more from one drug while some should opt for the other.
About 20% of kidney disease patients die within one year after they start dialysis and more than half die after five years - mostly from heart disease. Two classes of drugs, called angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs), act in a similar way to prevent and treat heart disease in the general population. Studies of the drugs in dialysis patients are scarce.
ACE inhibitors and ARBs primarily lower blood pressure, but they also decrease inflammation and can produce other beneficial effects for patients. T. Alp Ikizler, MD (Vanderbilt University Medical Center) and his colleagues looked to see if there is a difference between ACE inhibitor and ARB treatments on dialysis patients' heart health.
The researchers randomized 15 dialysis patients to receive an ACE inhibitor, an ARB, or a placebo for one week. Then patients received no treatment for three weeks, after which they were again randomized to receive an ACE inhibitor, an ARB, or a placebo for one week. This wash-out/treatment cycle was then conducted once more. Tests were conducted after each treatment cycle.
The investigators found that ARBs were more effective at fighting inflammation while ACE inhibitors were better at preventing blood vessel damage. Both of these properties could help prevent heart disease. The results suggest that ACE inhibitors and ARBs have different effects on dialysis patients' heart health that go beyond their similar blood pressure - lowering capabilities.
"The implication is that the choice of each of the drugs in dialysis patients could depend on the profile of each individual considered for treatment, which would be a more personalized approach to therapy," said Dr. Ikizler. This implies that different dialysis patients might respond to each drug differently and that some would get the most benefit from ACE inhibitors while others would benefit more from ARBs. The findings emphasize the need for a long-term randomized clinical trial to compare the effects of ARBs and ACE inhibitors on different aspects of heart health in dialysis patients.
Study co-authors include Jorge Gamboa MD, Mias Pretorius MD, Deanna Todd-Tzanetos MD, James M. Luther MD, Chang Yu, PhD, and Nancy J. Brown MD (Vanderbilt University Medical Center).
Disclosures: Dr. Ikizler is a consultant to Abbott Renal, Abbott Nutrition, Renal Advantage, Inc., AMGEN, Novartis, Bristol Myers Squibb, and Baxter Renal. Dr. Brown is a consultant for Novartis, Merck, and Boehringer-Ingelheim.
Article adapted by Medical News Today from original press release. Click 'references' tab above for source.Visit our blood / hematology section for the latest news on this subject. "Comparative Effects of Angiotensin-Converting Enzyme Inhibition and Angiotensin-Receptor Blockade on Inflammation during Hemodialysis" online at http://jasn.asnjournals.org/ December 8, 2011, doi: 10.1681/ASN.2011030287.
The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
American Society of Nephrology
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vineri, 9 decembrie 2011
Similar Blood Pressure Drugs Could Have Different Impacts On Dialysis Patients' Heart Health
Also Included In: Urology / Nephrology
Article Date: 09 Dec 2011 - 2:00 PST
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Two seemingly similar blood pressure lowering drugs have different effects on the heart health of dialysis patients, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The results indicate that certain dialysis patients may benefit more from one drug while some should opt for the other.
About 20% of kidney disease patients die within one year after they start dialysis and more than half die after five years mostly from heart disease. Two classes of drugs, called angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs), act in a similar way to prevent and treat heart disease in the general population. Studies of the drugs in dialysis patients are scarce.
ACE inhibitors and ARBs primarily lower blood pressure, but they also decrease inflammation and can produce other beneficial effects for patients. T. Alp Ikizler, MD (Vanderbilt University Medical Center) and his colleagues looked to see if there is a difference between ACE inhibitor and ARB treatments on dialysis patients' heart health.
The researchers randomized 15 dialysis patients to receive an ACE inhibitor, an ARB, or a placebo for one week. Then patients received no treatment for three weeks, after which they were again randomized to receive an ACE inhibitor, an ARB, or a placebo for one week. This wash-out/treatment cycle was then conducted once more. Tests were conducted after each treatment cycle.
The investigators found that ARBs were more effective at fighting inflammation while ACE inhibitors were better at preventing blood vessel damage. Both of these properties could help prevent heart disease. The results suggest that ACE inhibitors and ARBs have different effects on dialysis patients' heart health that go beyond their similar blood pressure lowering capabilities.
"The implication is that the choice of each of the drugs in dialysis patients could depend on the profile of each individual considered for treatment, which would be a more personalized approach to therapy," said Dr. Ikizler. This implies that different dialysis patients might respond to each drug differently and that some would get the most benefit from ACE inhibitors while others would benefit more from ARBs. The findings emphasize the need for a long-term randomized clinical trial to compare the effects of ARBs and ACE inhibitors on different aspects of heart health in dialysis patients.
Article adapted by Medical News Today from original press release. Source: American Society of NephrologyVisit our heart disease section for the latest news on this subject. American Society of Nephrology Please use one of the following formats to cite this article in your essay, paper or report:
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9 Dec. 2011.
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