Despite achieving hypertension control, the majority of obese patients did not achieve clinically significant weight loss. Effective weight loss interventions with dedicated hypertension treatment are needed to decrease cardiovascular events in this high-risk population.

Objective The presence of a mental health disorder with hypertension is associated with higher cardiovascular disease mortality than hypertension alone. Although earlier detection of hypertension has been demonstrated in patients with anxiety and depression, the relationship of mental health disorders to hypertension control is unknown. Our objective was to evaluate rates and predictors of incident hypertension control among patients with anxiety and/or depression compared to patients without either mental health diagnosis. Methods A four-year retrospective analysis included 4362 patients, ≥18 years old, who received primary care in a large academic group practice from 2008–2011. Patients met JNC 7 criteria and had a hypertension diagnosis. Kaplan-Meier analysis estimated the probability of achieving control for patients with and without anxiety and/or depression. Cox proportional hazard models were fit to identify predictors of time to control. Results Overall, 13% (n=573) had a baseline diagnosis of anxiety and/or depression. Those with anxiety and/or depression demonstrated more primary care and specialty visits than those without either condition. After adjustment, patients with anxiety and/or depression had faster rates of hypertension control (HR 1.22; 1.07–1.39) than patients without either diagnosis. Other associations of faster hypertension control included female gender (HR 1.32; 1.20–1.44), absence of tobacco use (HR 1.17; 1.03–1.33), Medicaid use (HR 1.27; 1.09–1.49), and a higher Adjusted Clinical Group Risk Score (HR 1.13; 1.10–1.17), a measure of healthcare utilization. Conclusions Greater healthcare utilization among patients with anxiety and/or depression may contribute to faster hypertension control.

Aims To gain insight into the differences in demographics of STEMI patients in Asia-Pacific, as well as inter-country variation in treatment and mortality outcomes. Methods Systematic review of published studies and reports from known registries in Australia, Japan, Korea, Singapore and Malaysia that began data collection after the year 2000. Supplementary self-report survey questionnaire on public health data answered by representative cardiologists working in these countries. Results 20 studies comprising of 158420 patients were included in the meta-analysis. The mean age was 61.6 years. CKD prevalence was higher in Japan, whilst dyslipidemia was low in Korea. Use of aspirin, P2Y12 inhibitors and statins were high throughout, but ACEi/ARB and B-blocker prescriptions were lower in Japan and Malaysia. Reperfusion strategies varied greatly, with high rates of primary PCI in Korea (91.6%), whilst Malaysia relies far more on fibrinolysis (72.6%) than primary PCI (9.6%). Likewise, mortality differed, with one-year mortality from STEMI was considerably greater in Malaysia (17.9%) and Singapore (11.2%) than in Korea (8.1%), Australia (7.8%) and Japan (6.2%). The countries were broadly similar in development and public health indices. Singapore has the highest gross national income and total healthcare expenditure per capita while Malaysia has the lowest. Primary PCI is available in all countries 24/7/365. Conclusion Despite broadly comparable public health systems, differences exist in patient profile, in-hospital treatment and mortality outcomes in these 5 countries. Our study reveals areas for improvements. The authors advocate further registry-based multi-country comparative studies focused on the Asia-Pacific region.

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Background. Asthma is a chronic condition that results in the inflammation and narrowing of airways, often clinically presenting as wheeze and shortness of breath. Little is known of the mechanisms of action (MOA) of herbs used to treat asthma. The aim of this study is to review existing data regarding known MOA of traditional Chinese medicine which will aid in the understanding of possible interactions between Western drugs and Chinese herbs as well as the standardization of management via a proposed guideline to improve patient safety and possible synergism in the long term. Methods. We searched through 5 databases for commonly prescribed herbs and formulas for asthma and narrowed down the search to identify the underlying MOA of individual herbs that could specifically target asthma symptoms. We included studies that stated the MOA of individual herbs when used for treating symptoms of asthma, excluding them if they are described as part of a formula. Results. A total of 26 herbs commonly prescribed for asthma with known mechanism of action were identified. Herbs used for asthma were found to have similar MOA as that for drugs. Based on existing GINA guidelines, a guideline is proposed which includes a total of 5 steps depending on the severity of asthma and the herbs’ MOA. 16 formulas were subsequently identified for the management of asthma, which consist of 12 “stand-alone” and 4 “add-on” formulas. “Stand-alone” formulas used independently for asthma generally follow the GINA guidelines but do not proceed beyond step 3. These formulas consist mainly of beta-agonist and steroid-like effects. “Add-on” formulas added as adjunct to “stand-alone” formulas, however, mainly act on T helper cells or have steroid-like effects. Conclusion. Through the understanding of MOA of herbs and their respective formulas, it will ensue greater patient safety and outcomes.

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