Current medical research and opinion
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Administration of high intensity statins prior to percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) or stable coronary artery disease has been shown to reduce short-, mid-, and long-term cardiovascular disease (CVD) morbidity and mortality as well as overall mortality compared with lower intensity statins or no statin treatment. The mechanisms involved are probably related to the pleiotropic effects of statins. ⋯ A decreased risk of contrast-induced nephropathy (CIN) post-PCI might be an extracardiac mechanism that contributes to the reduction in all cause and CVD mortality. These results support the need for the administration of statins before PCI.
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Editorial Comment
Sepsis and beta-blockade: a look into diastolic function.
There is growing interest on the modulation of the overwhelming sympathetic response of septic patients. Beta-blockers appear promising in this respect and, although we are at early stage, one large trial and a smaller one have demonstrated major beneficial effects. ⋯ It should be also considered that septic patients are at higher risk of cardiac arrhythmias and beta-blocker may have a protective effect in this regard. We are still at a preliminary stage and more research is needed it seems reasonable that beta-blockade will become an option for the treatment of septic patients over the next few years.
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Recent promising findings indicate a possible benefit of β-blockade in septic patients. Ongoing trials on esmolol in septic shock are investigating its hemodynamic effects, focusing on heart rate control and echocardiographic changes, as well as potential anti-inflammatory effects. However, given the complex physiology of sepsis and pharmacological effects on β-blockade, large multi-center trials are essential before such a therapy may be applied safely.
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Although the need for combination therapy of hypertension was obvious from the early intervention trials, administration of such therapy as fixed-dose or single-pill combinations has only reached general acceptance in recent years. The main reason for this change of mind documented in the recommendation of using single-pill combinations in almost every recent hypertension guideline is our increasing knowledge about non-adherence to drug therapy. In the multifactorial origin of non-adherence, the complexity of therapy, especially in elderly patients with comorbidities and polypharmacy, has been identified as a major factor involved. So an important rule in hypertension treatment, and maybe in drug therapy in general, is to keep things as simple as possible.