Angiotensin-converting Enzyme Inhibitors Research Articles

Association between body mass index and clinical outcomes in patients with acute myocardial infarction and reduced systolic function: Analysis of PARADISE-MI trial data.

The relationship between body mass index (BMI) and clinical outcomes in patients with cardiovascular disease, including acute heart failure (AHF) and acute myocardial infarction (AMI), remains debated. This study investigates the association between BMI and clinical outcomes within the PARADISE-MI cohort, while also evaluating the impact of angiotensin receptor-neprilysin inhibitor (ARNI) versus angiotensin-converting enzyme inhibitor (ACE-I) treatment on this relationship. The analysis included 5589 patients from the PARADISE-MI study with available baseline BMI data. The cohort comprised patients with AMI and pulmonary congestion and/or left ventricular ejection fraction ≤40%. Patients were categorized into six World Health Organization BMI subgroups. The primary outcome of interest was the composite endpoint of cardiovascular death, heart failure (HF)-associated hospitalization, and outpatient symptomatic HF episodes. The mean baseline BMI of the cohort was 28.1 ± 5.0 kg/m2. The lowest rate of the primary composite endpoint (6.2/100 patient-years) was observed in overweight patients (BMI 25-29.9 kg/m2), while the highest rates were found in the lowest and highest BMI subgroups (8.4/100 patient-years for BMI <18.5 kg/m2 and 9.7/100 patient-years for BMI >40 kg/m2). There was no significant interaction between BMI and the treatment effect of ARNI versus ACE-I on the primary composite outcome (p = 0.73). Additionally, no significant differences in the incidence of adverse events or serious adverse events were noted across the BMI subgroups. In AMI with AHF patients, the relationship between BMI and the primary composite outcome is non-linear, with the lowest event rates observed in overweight individuals. Outcomes and safety profiles for ARNI and ACE-I treatments were similar across BMI subgroups.

Polypharmacy among patients with asthma

ABSTRACT. Medical interventions are intended to benefit patients, but they can be threatening. Polypragmasia (problematic polypharmacy) is the inappropriate use of multiple medications or duplicate medications. Appropriate polypharmacy is the rational necessary and justified use of several drugs (5 or more) for the treatment of several concomitant diseases. Risk factors for polypragmasia include polymorbidity, advanced age, self-medication, and others. All these factors are inherent in bronchial asthma. Problematic polypharmacy in asthma is caused, among other, by the excessive use of salbutamol, which characterizes by a wide range of drug-drug interactions. Medications implicated in polypharmacy in asthmatics include asthma medications, antihistamines, anti-infective, cardiovascular agents, antidiabetics, gastrointestinal, anticonvulsants, antidepressants, antipsychotics, anxiolytics, sedatives, hypnotics, contraceptives and analgesics. Drugs that have a negative impact on the course of asthma in patients with comorbidities are angiotensin-converting enzyme inhibitors, proton pump inhibitors, antipsychotics and antibiotics. Problematic polypharmacy (polypragmasia) needs correction. Tackling problematic polypharmacy requires tailoring the use of medicines to individual circumstances and may involve the process of deprescribing. Deprescribing can cause anxiety and concern for clinicians and patients. An optimal approach for targeting patients with problematic polypharmacy is yet to be determined.

Non-persistence with multiple secondary prevention medications for peripheral arterial disease among older hypertensive patients

IntroductionThe benefit of secondary prevention in hypertensive patients with peripheral arterial disease (PAD) is based on continual simultaneous taking of statins, antiplatelet agents and antihypertensive agents, preferably angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). Our study was aimed at a) the analysis of the extent of non-persistence with multiple medication classes, and b) identifying factors associated with the likelihood of non-persistence.MethodsIn our cohort study, 3,401 hypertensive patients (1,853 females and 1,548 males) aged ≥65 years treated simultaneously with statins, antiplatelet agents and ACEIs/ARBs and in whom PAD was newly diagnosed during 2012 were analysed. A patient was classified as non-persistent when he/she was non-persistent with at least one of the three analysed medication classes. The most important characteristics associated with the probability of non-persistence were identified using the Cox regression.ResultsAt the end of the follow-up period (mean length 1.8 years), 1,869 (55.0%) patients (including 1,090 females and 779 males) were classified as non-persistent. In the whole study cohort, factors associated with non-persistence were female sex, atrial fibrillation, and being a new user of at least one of the analysed medication classes; in males, they were university education, atrial fibrillation, and epilepsy, and, in females, being a new user.ConclusionIdentification of sex differences in factors associated with non-persistence makes it possible to determine the groups of patients in whom special attention should be paid to improving their persistence with a combination of medicines in order to ensure successful secondary prevention of PAD.

Safety of Calcium Channel Blockers in Patients With Severe Aortic Stenosis and Hypertension.

There is a paucity of data on safety of calcium channel blockers (CCB) in patients with severe aortic stenosis (AS) and hypertension. Among 2,460 patients with severe AS and hypertension receiving antihypertensive therapy in the CURRENT AS registry-2, we compared the clinical outcomes between patients taking antihypertensive therapy with CCB (CCB group) and without CCB (no CCB group). In the entire study population, CCB was prescribed in 1,763 patients (71.7%), which was the most commonly prescribed antihypertensive agents. The prescription rates of angiotensin converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, and thiazides were 61.9%, 25.6%, and 7.3% in the CCB group, and 75.8%, 54.4%, and 6.0% in the no CCB group. In the propensity score matched cohort, the cumulative 3-year incidence of all-cause death or hospitalization for heart failure was not different between the CCB and no CCB groups (38.3% vs. 38.7%, log-rank P=0.65; HR, 0.94; 95%CI, 0.77-1.15; P=0.56). The cumulative 3-year incidence of syncope was low regardless of CCB prescription (1.1% vs. 1.0%, P=0.74). Among patients with severe AS and hypertension, CCB was the most commonly prescribed antihypertensive agents, and antihypertensive therapy with CCB was associated with comparable clinical outcomes to antihypertensive therapy without CCB. Syncope was rarely seen in patients with severe AS and hypertension receiving antihypertensive therapy regardless of CCB prescription.

Associations of sarcopenia and malnutrition with 30-day in-hospital morbidity and mortality after cardiac surgery.

Sarcopenia and malnutrition often occur simultaneously in adults with cardiovascular diseases. Our objective was to determine the associations of preoperative sarcopenia and malnutrition with major adverse cardiac and cerebral events (MACCE) after cardiac surgery. We retrospectively analyzed 154 consecutive patients who underwent elective cardiac surgery between January 2015 and June 2018 at two institutions in Japan. Sarcopenia and nutritional status were preoperatively assessed by bilateral psoas muscle volume index (PMVI) using CT scans and the prognostic nutritional index (PNI), respectively. The median age in the total cohort was 69 years, and 43% were women. Within 30 days after surgery, 20 patients developed in-hospital MACCE and 7 patients died of any cause. Low PMVI (<72.25 cm3/m2) and low PNI (<48.15) were each independent predictors of postoperative MACCE occurrence with odds ratios (95% confidence interval) of 3.58 (1.22-10.53) and 3.73 (1.25-11.09) when adjusted for age and sex, and 3.25 (1.07-9.87) and 3.27 (1.08-9.89) when adjusted for preoperative left ventricular ejection fraction, angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker, and anticoagulant. In addition, the combination of low PMVI and low PNI conferred the highest risk of in-hospital MACCE among the 4 groups (ie, the low PMVI, low PNI, low PMVI+low PNI, and neither low PMVI nor low PNI groups). Preoperative low PMVI and low PNI were respectively associated with 30-day in-hospital MACCE occurrence after cardiac surgery. Notably, coexistence of these reductions further enhanced the risk of postoperative MACCE.

Angiotensin-Converting Enzyme Inhibitor (ACEI) and Angiotensin Receptor Blocker (ARB) Use are Associated With Increased Readmission After Ileostomy Creation.

High output is a common cause for readmission after new ileostomy creation. The loss of sodium leads to compensatory activation of the renin-angiotensin-aldosterone system (RAAS). Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are first-line therapy for hypertension in the United States. We hypothesized that concurrent use of ACEI/ARB increases the risk of readmission following new ileostomy creation due to the loss of this compensatory mechanism. Patients undergoing ileostomy creation between 2009-2022 at an integrated managed health care system were included in this retrospective study. Primary outcomes were hospital readmission and ED visit within 30-days. Additional variables included ACEI/ARB use, ileostomy type, Charlson Comorbidity Index, additional antihypertensives at discharge (furosemide, hydrochlorothiazide, spironolactone, amlodipine, nifedipine, and diltiazem), and readmission diagnosis. Descriptive and advanced statistical analysis was completed with SPSS. Of 540 patients, 41.9% were readmitted or visited an ED within 30 days. There was no difference in readmission or ED visit based on age, gender, or ileostomy type. Patients discharged with ACEI/ARB (37.4% vs 25.5%, P = .005) and additional antihypertensives (37.2% vs 17.3%, P = .006) were at a higher risk for readmission. Inhibition of RAAS is associated with increased risk for hospital readmission. In patients with hypertension undergoing ileostomy creation, individualized care plans are needed with earlier antimotility agent use or intravenous rehydration plans.

Vasodilator drugs and heart-related outcomes in systemic sclerosis: an exploratory analysis

Background and aimsSystemic sclerosis (SSc) is an autoimmune connective disease characterised by excessive extracellular matrix deposition and widespread skin and internal organ fibrosis including various cardiac manifestations. Heart involvement is...

QSAR Modeling of Substituted Benzimidazole Derivative as Angiotensin II-AT1 Receptor Antagonist: WHIM Descriptors

Selective inhibition of Angiotensin II (Ang II) is an important strategy for design of Ang II-AT1 receptor antagonist which is devoid of the common side effects of angiotensin converting enzyme inhibitors (ACEIs). QSAR study of 4, 5, 6, and 7 substituted benzimidazole analogs were performed using Dragon 2.1 (Milano Chemometrics) for antagonism of Ang II. The study was carried out on 33 compounds; mathematical models were obtained by means of the sequential multiple linear regression analysis (SMLR). QSAR analysis have produced good predictive models and give statistically significant correlations of selective Ang II antagonism with WHIM descriptors concerning size, symmetry, shape and distribution of molecules atom. The predictive ability of the resulting QSAR model was evaluated by cross validated correlation coefficient (q2 = 0.659). It was able to describe more than 68% of the variance in the experimental activity. This QSAR study helps in design and prediction of Ang II inhibitory activity of novel substituted benzimidazole Ang II-AT1 receptor antagonist.

ACE inhibitors versus angiotensin receptor-neprilysin inhibitors for HFrEF management: A prospective cohort study from Indonesia

Previous studies have reported that angiotensin receptor-neprilysin inhibitors (ARNI) are superior to angiotensin-converting enzyme inhibitors (ACEI) in treating heart failure with reduced ejection fraction (HFrEF). Unfortunately, previously published studies predominantly focused on Western populations, while the data remains insufficient in developing countries. The aim of this study was to compare the efficacies of ARNI and ACEI on patients with HFrEF in Indonesia. A prospective cohort study was conducted among heart failure patients at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Both ACEI and ARNI each consisted of 40 subjects receiving standard treatment for heart failure. Left ventricular ejection fraction (LVEF), quality of life (QoL), suppression of tumorigenicity 2 (ST2), and troponin T were measured upon admission and at the end of the follow-up. In addition, the occurrence of major adverse cardiac events (MACE) was observed during 6 months of follow-up. Paired t-test was used to compare the outcomes of ACEI and ARNI. The results revealed that KKCQ score and LVEF were improved in both ARNI and ACEI groups (each with p&lt;0.001). A higher KCCQ overall score was observed in the ARNI group in contrast to the ACEI group (p=0.01). ARNI demonstrated superior results in improving the ejection fraction as compared with ACEI (p=0.001). Troponin T and ST2 levels exhibited no significant difference between the two groups (p=0.07 and 0.286, respectively). MACE-associated mortality (p=0.696) and rehospitalization (p=0.955) were identical between both groups. In conclusion, ARNI was more efficacious than ACEI in improving the quality of life and left ventricular ejection fraction of patients with HFrEF. However, the efficacy was not significantly different in reducing the risk of MACE.

Genetic polymorphisms influencing antihypertensive drug responses.

Hypertension is a major contributor to cardiovascular disease and its associated morbidity and mortality. The low efficacy observed with some anti-hypertensive therapies has been attributed partly to inter-individual genetic variability. This paper reviews the major findings regarding these genetic variabilities that modulate responses to anti-hypertensive therapies such as angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), diuretics, calcium channel blockers (CCBs) and β-adrenoceptor blockers. The importance of studying these genetic polymorphisms stems from the goal to optimise anti-hypertensive therapy for each individual patient, aiming for the highest efficacy and lowest risk of adverse effects. It is important to recognise that environmental and epigenetic factors can contribute to the observed variations in drug responses. Owing to the multigenic and multifactorial nature of drug responses, further research is crucial for translating these findings into clinical practice and the establishment of reliable recommendations.

BMY 7378, a selective α1D-adrenoceptor antagonist, is a new angiotensin converting enzyme inhibitor: In silico, in vitro and in vivo approach

BMY 7378 is a multitarget drug primarily known for its selective antagonism of α1D-adrenoceptors (α1D-AR), exhibiting both hypotensive effects and the ability to prevent or reverse angiotensin II-induced vascular hypertrophy. Notably, BMY 7378 contains a phenylpiperazine moiety, a structural feature associated with angiotensin-converting enzyme (ACE) inhibition. This study aimed to investigate ACE inhibition as a potential pharmacological mechanism of BMY 7378. Using an in silico approach we predicted BMY 7378 interactions with the ACE active site, followed by in vitro activity assays. Additionally, ACE protein expression in the heart was analyzed following four weeks of BMY 7378 treatment in 7–8-month-old spontaneously hypertensive rats (SHR). All assays were benchmarked against captopril, a standard ACE inhibitor. In silico results showed that BMY 7378 binds to the ACE active site, though with reduced interaction with Zn701 (73.7 % compared to captopril), likely due to the pKa of its amino group. The inhibitory concentration 50 (IC50) for BMY 7378 was 136 μM, lower than other reported phenylpiperazine derivatives. Furthermore, BMY 7378 significantly increased ACE expression in the hearts of SHR, with an increase of 8.5-fold compared to captopril. In conclusion, BMY 7378 exhibits dual activity as an α1D-AR antagonist and an ACE inhibitor, making it a promising pharmacological tool for investigating and potentially treating hypertension and its associated cardiovascular complications.

Association of ACEI/ARB therapy with total and cardiovascular death in coronary artery disease patients with advanced chronic kidney disease: a large multi-center longitudinal study.

Advanced chronic kidney disease (CKD) is common among patients with coronary artery disease (CAD), and angiotensin‑converting enzyme inhibitors (ACEI) or angiotensin‑receptor blockers (ARB) can improve cardiac and renal function, but whether ACEI/ARB therapy improves long-term prognosis remains unclear among these high-risk patients. Therefore, this research aimed to investigate the relationship between ACEI/ARB therapy and long-term prognosis among CAD patients with advanced CKD. CAD patients with advanced CKD were included in five hospitals. Advanced CKD was defined as estimated glomerular filtration rate (eGFR)<30 ml/min per 1.73 m2. Cox regression models and competing risk Fine and Gray models were used to examine the relationship between ACEI/ARB therapy and all-cause and cardiovascular death, respectively. Of 2527 patients, 47.6% population of our cohort was discharged on ACEI/ARB. The overall all-cause and cardiovascular mortality were 38.6% and 24.7%, respectively. Multivariate Cox regression analyses indicated that ACEI/ARB therapy was found to be associated with lower rates of both all-cause mortality (hazard ratio (HR)=0.836, 95% confidence interval (CI): 0.738-0.948, p = 0.005) and cardiovascular mortality (HR = 0.817, 95%CI: 0.699-0.956, p = 0.011). In the propensity-matched cohort, the survival benefit was consistent, and significantly better survival was observed for all-cause mortality (HR = 0.856, 95%CI: 0.752-0.974, p = 0.019) and cardiovascular mortality (HR = 0.830, 95%CI: 0.707-0.974, p = 0.023) among patients treated with ACEI/ARB. ACEI/ARB therapy showed a better survival benefit among high-risk CAD patients with advanced CKD at long-term follow-up, which manifested that strategies to maintain ACEI/ARB treatment may improve clinical outcomes among these high-risk populations.

Polygenic and transcriptional risk scores identify chronic obstructive pulmonary disease subtypes in the COPDGene and ECLIPSE cohort studies

Genetic variants and gene expression predict risk of chronic obstructive pulmonary disease (COPD), but their effect on COPD heterogeneity is unclear. We aimed to define high-risk COPD subtypes using genetics (polygenic risk score, PRS) and blood gene expression (transcriptional risk score, TRS) and assess differences in clinical and molecular characteristics. We defined high-risk groups based on PRS and TRS quantiles by maximising differences in protein biomarkers in a COPDGene training set and identified these groups in COPDGene and ECLIPSE test sets. We tested multivariable associations of subgroups with clinical outcomes and compared protein-protein interaction networks and drug repurposing analyses between high-risk groups. We examined two high-risk omics-defined groups in non-overlapping test sets (n=1133 NHW COPDGene, n=299 African American (AA) COPDGene, n=468 ECLIPSE). We defined "high activity" (low PRS, high TRS) and "severe risk" (high PRS, high TRS) subgroups. Participants in both subgroups had lower body-mass index (BMI), lower lung function, and alterations in metabolic, growth, and immune signalling processes compared to a low-risk (low PRS, low TRS) subgroup. "High activity" but not "severe risk" participants had greater prospective FEV1 decline (COPDGene:-51mL/year; ECLIPSE:-40mL/year) and proteomic profiles were enriched in gene sets perturbed by treatment with 5-lipoxygenase inhibitors and angiotensin-converting enzyme (ACE) inhibitors. Concomitant use of polygenic and transcriptional risk scores identified clinical and molecular heterogeneity amongst high-risk individuals. Proteomic and drug repurposing analysis identified subtype-specific enrichment for therapies and suggest prior drug repurposing failures may be explained by patient selection. National Institutes of Health.

Has APOL1 kidney disease treatment been hiding in plain sight?

Two coding variants of APOL1 account for much of the excess risk of focal segmental glomerulosclerosis in people of recent West African ancestry. There is an unmet need of treatment for apolipoprotein L1 kidney disease. In this issue, Sula Karreci etal. reported that lisinopril reduced proteinuria and glomerulosclerosis in a mouse model of apolipoprotein L1-induced focal segmental glomerulosclerosis, in a genotype-specific manner. By contrast, hydralazine and dapagliflozin had no effect. This study highlights the potential therapeutic utility of angiotensin-converting enzyme inhibitor in apolipoprotein L1 kidney disease.

Four-step continuous-flow biosynthesis of a chiral precursor for angiotensin-converting enzyme inhibitors

Four-step continuous-flow biosynthesis of a chiral precursor for angiotensin-converting enzyme inhibitors

Identification of potentially causative drugs associated with hypotension: A scoping review.

Drug-induced hypotension can be harmful and may lead to hospital admissions. The occurrence of hypotension during drug therapy is preventable through increased awareness. This scoping review aimed to provide a comprehensive overview of antihypertensive and nonantihypertensive drugs associated with hypotension in adults. A systematic literature search was conducted using MEDLINE, Embase and Cochrane Library, focusing on studies from January 2013 to May 2023. Search terms were developed to capture key concepts related to hypotension and adverse drug events in adults while excluding terms related to allergic reactions, phytotherapy and studies involving paediatric, pregnant or animal populations. The eligibility criteria included a wide range of study types evaluating hypotension as an adverse drug event across all healthcare settings. Relevant information was extracted from the included studies, while identified drugs associated with hypotension were categorised into drug classes. The review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. In 97 eligible studies, we identified 26 antihypertensive drugs grouped into nine different antihypertensive classes and 158 other drugs grouped into 22 other drug classes. Common antihypertensive classes were angiotensin-converting enzyme inhibitors, beta blockers and diuretics. Frequently reported nonantihypertensive classes were neuroleptics, alpha-1 blockers for benign prostatic hyperplasia, benzodiazepines, opioids and antidepressants. The results highlight the importance of healthcare professionals being aware of nonantihypertensive drugs that can cause hypotension. This review provides a basis for future systematic reviews to explore dose-dependence, drug-drug interactions and confounding factors.

Exploring the antihypertensive potential of natural compounds from Zygophyllum sp plant: An in-silico investigation of ACE inhibition

Abstract Hypertension, a major contributor to global mortality, requires comprehensive management including lifestyle changes and medication. This study explores the potential of natural compounds from Zygophyllum sp as Angiotensin-converting enzyme (ACE) inhibitors, a key class of antihypertensive drugs. Using molecular docking methodology, we investigated the inhibitory effects of these compounds on the ACE enzyme (PDB: 1UZF). Our work demonstrated that several molecules exhibited promising binding scores compared to established reference ligands, suggesting potential ACE-inhibiting properties. Myristic acid showed the most favorable score (-9.2454 kcal/mol), surpassing conventional reference drugs. Geranyllinalool, Pseudophytol, Methyl linoleate and Phytol also demonstrated superior scores. 1-Octadecene and linoleic acid outperformed captopril and aligned closely with other reference ligand scores. The computational scores, largely exceeding those of established drugs, indicate strong affinities between Zygophyllum sp ’ s chemical constituents and the ACE enzyme. This suggests potential antihypertensive properties of the plant and its bioactive components, supporting its traditional use as an antihypertensive remedy. The notable efficacy scores of select known therapeutic agents further validate this potential. However, additional in-vitro and in-vivo investigations are necessary to robustly establish the ACE-inhibitory capability of Zygophyllum sp compounds. This study provides a foundation for further research into natural antihypertensive treatments, potentially offering new avenues for managing this widespread health concern.

Prescription Fills Among Patients With Type 2 Diabetes After Hospitalization for Acute Coronary Syndrome

Individuals with type 2 diabetes (T2D) have high rates of mortality following myocardial infarction (MI). Hospitalization is an opportunity to initiate or continue evidence-based treatment to reduce risk in individuals with T2D and acute coronary syndrome (ACS). To determine patterns of evidence-based medication use during the period of transition from admission to discharge after hospitalization for MI or coronary revascularization among individuals with T2D and ACS. This retrospective cohort study used data from the Centers for Medicare & Medicaid Services (CMS) for January 1, 2018, to June 30, 2020. Medicare beneficiaries older than 18 years with T2D with a qualifying hospitalization were included. Individuals were followed before admission (90 days prior), at discharge (≤90 days), and after discharge (91-180 days after) from a hospitalization for MI or coronary revascularization. Data analysis was performed in June 2023. Demographic data (race, sex, rural vs urban location of care, and comorbidities) were abstracted from CMS data using Master Beneficiary and Summary Files and International Statistical Classification of Diseases, Tenth Revision codes. Medicare Part D prescription fill records were examined for the following agents: (1) angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNIs); (2) β-blockers; (3) platelet adenosine diphosphate receptor inhibitors (P2Y12Is); (4) statins or proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9Is); and (5) glucagon-like peptide 1 receptor agonists (GLP-1RAs) or sodium glucose cotransporter 2 inhibitors (SGLT2Is). Logistic regression analysis was used to examine the association between covariates and lack of prescription fills in the postdischarge period. A total of 188 651 eligible Medicare beneficiaries with T2D and hospitalization for MI or coronary revascularization were identified. Their median age was 73.0 (IQR, 67.0-79.0) years, and more than half (111 982 [59.4%]) were men; 18 383 (9.7%) were Black and 153 461 (81.3%) were White. Not filling a cardiovascular medication after hospitalization was associated with not filling that medication at the time of discharge (adjusted risk ratio, 0.27 [95% CI, 0.27-0.28] for ACEIs, ARBs, or ARNIs; 0.24 [0.24-0.25] for β-blockers; 0.20 [0.19-0.20] for P2Y12Is; 0.31 [0.31-0.32] for statins or PCSK9Is; and 0.27 [0.26-0.28] for SGLT2Is or GLP-1RAs). In this cohort study of Medicare beneficiaries with T2D, longer-term medication use following hospitalization for MI was associated with medication use at the time of discharge. These findings highlight the critical importance of this period to optimize preventive care for these high-risk individuals. Further implementation science research is needed to develop strategies to improve use of these evidence-based medications.

Current aspects of differential diagnosis and treatment of cough

Cough is a common and important respiratory symptom that can cause significant complications for patients and be a diagnostic challenge for physicians. An organized approach to the evaluation of cough begins with classifying it as acute, subacute, or chronic based on duration and time of onset. Acute cough (up to 3 weeks) is most often one of the main symptoms of acute respiratory viral infections and acute bronchitis. Subacute cough, lasting from 3 to 8 weeks, is usually postinfectious postviral in origin. Common causes of chronic cough lasting more than 8 weeks with a normal chest X-ray are cough variant of bronchial asthma, chronic obstructive pulmonary disease, upper airway cough syndrome / postnasal drip syndrome, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux, and medications (primarily angiotensin-converting enzyme inhibitors). The spectrum of possible causes of cough is diverse, however, respiratory pathology comes to the forefront in the differential diagnostic search. Successful treatment of cough is an important task in clinical practice. Given the possible multicomponent nature of cough, the presence of catarrhal-respiratory and broncho-obstructive syndromes in the clinical picture along with bronchitis syndrome, combination drugs become the drug of choice. In conclusion, the possibilities of a combined (bromhexine + guaifenesin + salbutamol) expectorant against cough, its effectiveness and safety are considered.

Frequency and progression of azotemia during acute and chronic treatment of congestive heart failure in cats.

Azotemia is common in cats with congestive heart failure (CHF) and might be exacerbated by diuretic therapy. Determine frequency, risk factors, and survival impact of progressive azotemia in cats treated for CHF. One hundred and sixteen client-owned cats with kidney function testing performed at least twice during acute or chronic CHF treatment. Serum creatinine (sCr) and electrolyte concentrations were determined at multiple clinical timepoints to detect azotemia and kidney injury (KI; sCr increase ≥0.3 mg/dL). Furosemide dosage between timepoints was calculated. Multivariable modeling was performed to identify predictors of KI, change in serum biochemistry results, and survival. Azotemia was common at all timepoints, including initial CHF diagnosis (44%). Kidney injury was documented in 66% of cats. Use of a furosemide continuous rate infusion was associated with increased risk of KI during hospitalization (odds ratio, 141.6; 95% confidence interval [CI], 12.1-6233; P = .01). Higher furosemide dosage was associated with increase in sCr during hospitalization (P = .03) and at first reevaluation (P = .01). Treatment with an angiotensin converting enzyme inhibitor was associated with fewer lifetime KI events (P = .02). Age in years was the only variable associated with shorter survival (hazard ratio, 1.1; 95% CI, 1.0-1.1; P = .03). Neither sCr nor KI were associated with long-term outcome. Azotemia and KI were common in cats during CHF treatment but did not impact survival.