Over the counter medicine Diclofenac caution Sir, Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) with analgesic, anti-inflammatory and antipyretic properties commonly used in low, middle and high-income countries and is available over the counter in most. 1,2 It is prescribed for third molar surgery, tooth extraction, root canal treatment, deep cavity preparation and acute dental pain. 1,3,4 Bally et al. 5 observed that patients taking any dose of NSAIDs for periods of one week or more had increased risk of myocardial infarction. Use of diclofenac for one to seven days increased the probability of this risk by 99% with greater risks for higher doses and in the first month of use. Arfe et al. 6 also observed that diclofenac was associated with increased risk of hospital admission for heart failure, the risk being doubled when used at very high doses (≥2 defined daily dose equivalents). Schmidt et al. observed that within a 30-day period of initiation, patients taking diclofenac were exposed to cardiovascular health risks such as atrial fibrillation or flutter, ischaemic stroke, heart failure, myocardial infarction, and cardiac death, when compared to non-use, paracetamol use, and use of other traditional NSAIDs. 2 In view of the cardiovascular risks thus identified, diclofenac should be available only on prescription and with adequate written warning but not prescribed for patients with previous myocardial infarction, heart failure and diabetes mellitus.
Introduction
The prevalence of hypertension is estimated to be nearly 50% among Brazilian adults. Achieving an adequate control of this CVD risk factor is challenging but truly relevant on a public health perspective, as this is the top-ranking cause of all deaths globally.
Purpose
We aimed to describe crude and simple metrics of blood pressure management (including its control), as based on current guideline-derived recommendations, after one year of the clinical practice registry
Methods
Patients with documented Hypertension were included by using electronic case report form based on the ACC PINNACLE Registry. The registry has been enrolling patients from general practitioners and specialists. The main goal of the PINNACLE program is to improve the quality of care in “real world” clinical practice. Patients data were evaluated after 01 year of follow-up on regular clinical appointments and the differences on clinical practice were evaluated
Results
Currently, PINNACLE-Brazil has enrolled 7598 patients, with 87% of diagnosed hypertension. Percentage of patients with a diagnosis of hypertension who had a blood pressure measurement <140/90 mmHg was 47.9% (baseline) and 57.3% (follow-up). Percentage of patients who had a blood pressure <140/90 mm Hg, or who had a blood pressure ≥140/90 mm Hg and were prescribed ≥2 antihypertensive medications were 67.1% on baseline and 71.2% after 1 year.
Conclusion
The preliminary data of PINNACLE Registry in Brazil shows that a significant proportion of hypertensive patients (nearly half) have not presented with adequate control of blood pressure levels and, moreover, a large proportion have not been treated with recommended combination of 02 or more antihypertensive medications to reach targeted BP levels the quality of care was improving after 01 year of registry.
Acknowledgement/Funding
ACC Foundation
Introduction
Lipid control is highly effective and improves clinical outcomes in coronary artery disease (CAD) patients, thus is one of the pillars of the cardiovascular secondary prevention.
Purpose
The aim of this preliminary analysis was to describe the lipid management in CAD patients in Brazil after one year of the clinical practice registry.
Methods
Patients with documented CAD were included by using electronic case report form based on the ACC PINNACLE Registry. The registry has been enrolling patients from general practitioners and specialists. Patients data were evaluated after 01 year of follow-up on regular clinical appointments and the differences on clinical practice were evaluated
Results
Currently, PINNACLE-Brazil enrolled individuals, with 2234 (29.4%) patients with CAD. Prescription of statin therapy was identified in 85.6% baseline and 78.3% follow-up. CAD patients with LDL-c <100 mg/dL were 47.3% baseline and 38.5% follow-up and at least one lipid profile assessment occurred in 60.9% baseline and 51.2% follow-up. CAD patients who have an LDL-c result <100 mg/dL, or >100 mg/dL with a documented plan to achieve LDL-c <100 mg/dL, were 48.1% (baseline) and 38.5% (follow-up).
Conclusion
The preliminary results of PINNACLE-Brazil show that, despite the relatively high prescription rate of statin therapy, LDL-c targeted level for CVD secondary prevention has not been achieved in the majority of patients after 01 year of follow-up. Nationwide knowledge translation initiatives are needed to improve the CVD burden in Brazil
Acknowledgement/Funding
ACC Foundation
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.