2020 in a nutshell: The hottest developments in the field of cardiology this year. Section 1. General and preventive cardiology
2. BPLTTC (Blood Pressure Lowering Treatment Trialists Collaboration) trialBlood pressure medication can prevent heart attacks and strokes—even in people with normal blood pressure.
Debate continues over whether pharmacological blood pressure lowering is equally beneficial in people with, vs. without, a prior heart attack or stroke, and when blood pressure is below the threshold for hypertension (typically 140/90 mmHg). The BPLTTC study set out to examine these questions in detail with researchers combining data on 348 854 individuals who had participated in a randomized clinical trial and conducting a meta-analysis.Participants were divided into two groups: those with a prior diagnosis of cardiovascular disease and those without. Each group was divided into seven subgroups based on systolic blood pressure at study entry (less than 120, 120-129, 130-139, 140-149, 150-159, 160-169, 170 and above mmHg).Over an average four years of follow-up, each 5 mmHg reduction in systolic blood pressure lowered the relative risk of major cardiovascular events by about 10%. The risks for stroke, ischaemic heart disease, heart failure and death from cardiovascular disease were reduced by 13%, 7% and 14% and 5%, respectively.
Neither the presence of cardiovascular disease nor the level of blood pressure at study entry modified the effect of treatment.
"Greater drops in blood pressure with medication lead to greater reductions in the risk of heart attacks and strokes," said principal investigator Professor Kazem Rahimi of the University of Oxford, UK. "This holds true regardless of the starting blood pressure level, in people who previously had a heart attack or stroke, and in people who have never had heart disease." He adds, "This decision will depend on an individual's likelihood of suffering cardiovascular disease in the future – there are a number of risk calculators health professionals can use. Other factors to consider are the potential for side effects and the cost of treatment."Source: journal: PLOS Medicine: Karmali KN, Lloyd-Jones DM, et al Blood Pressure Lowering Treatment Trialists' Collaboration. Blood pressure-lowering treatment strategies based on cardiovascular risk versus blood pressure: A meta-analysis of individual participant data. PLoS Med. 2018 Mar 20;15(3):e1002538. doi: 10.1371/journal.pmed.1002538.
From addressing the concerns of ACE inhibitors in the COVID19 era to defining a new target population for antihypertensive treatment, the following trials from 2020 will serve as landmarks for future research. Here are some of the important trials of 2020 in the field of General and preventive cardiology
1. BRACE CORONA trial
Continuing Versus Suspending Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
Heart patients hospitalized with COVID-19 can safely continue taking common cardiac drugs.
Membrane-bound angiotensin-converting enzyme 2 (ACE2) is the functional receptor for SARS-CoV-2. Initial concerns and conflicting observational evidence about the potential clinical impact of ACE-inhibitors and ARBs on COVID-19 patients, compelled an urgent need for randomized clinical trial evidence.
The BRACE CORONA trial was an academic-led, phase 4, randomised study testing two strategies: temporarily stopping the ACE inhibitor/ARB for 30 days versus continuing ACE inhibitors/ARBs in patients who were taking these medications chronically and were hospitalised with a confirmed diagnosis of COVID-19. The primary outcome was the number of days alive and out of hospital at 30 days.
The trial enrolled 659 patients from 29 sites in Brazil. All participants were chronically using an ACE inhibitor or ARB and were hospitalised with COVID-19. Patients were randomly allocated to stopping the ACE inhibitor/ARB for 30 days or continuing the ACE inhibitor/ARB.
The BRACE CORONA Trial concluded that with patients hospitalized with COVID-19, suspending ACE inhibitors and ARBs for 30 days did not impact the number of days alive and out of hospital, so they should generally be continued for those with an indication.
"This is the first randomised data assessing the role of continuing versus stopping ACE inhibitors and ARBs in patients with COVID-19," said principal investigator Professor Renato Lopes of Duke Clinical Research Institute, Durham, US. "In patients hospitalised with COVID-19, suspending ACE inhibitors and ARBs for 30 days did not impact the number of days alive and out of hospital."
He concluded: "Because these data indicate that there is no clinical benefit from routinely interrupting these medications in hospitalised patients with mild to moderate COVID-19, they should generally be continued for those with an indication."
Source: European heart journal: Cardiovascular Research, Volume 116, Issue 14, 1 December 2020, Pages e198–e199, https://doi.org/10.1093/cvr/cvaa325
NEXT
Disclaimer: This site is primarily intended for healthcare professionals. Any content/information on this website does not replace the advice of medical and/or health professionals and should not be construed as medical/diagnostic advice/endorsement/treatment or prescription. Use of this site is subject to our terms of use, privacy policy, advertisement policy. © 2024 Minerva Medical Treatment Pvt Ltd