Sitagliptin treatment offers elderly patients aged ≥65 years efficacious and safe reductions in HbA1c values regardless of BMI. Geriatr Gerontol Int 2018; 18: 631-639.
Abstract:Currently, the prevalence of hypertension (HT), diabetes mellitus (DM), and hyperlipidemia (HL) is high, and these diseases are important risk factors for cardiovascular disease (CVD). Furthermore, patients with CVD often have more than one of these diseases. Generally, patients take multiple drugs for each disease. Therefore, clinicians must pay attention to drug interactions. Although HT, DM, and HL are different diseases, they share some of the same pathophysiological mechanisms and ultimately lead to the same cardiovascular events.Currently, most patients with CVD are treated with 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (statins), and various beneficial pleiotropic effects of statins have been reported since the 1990s.In this review, we evaluate the additional effects of antihyperlipidemic agents on blood pressure (BP).
Backgrounds: Although long-term treatment with beta-blockers has been shown to improve morbidity and mortality in dilated cardiomyopathy (DCM), patient re- sponses are heterogeneous. Methods: To establish the appropriate indication for the initiation of beta-blocker therapy, we retrospectively analyzed 38 DCM patients treated with beta-blockers (metoprolol or carvedilol) and examined differences in baseline profiles between patients who could continue the therapy (responders) and those who could not (non-responders). Results: In 13 non-responders, the duration from onset of symptoms to beta-blocker initiation was longer (p < 0.05), systolic blood pressure was lower (p < 0.001), serum sodium concentration was lower (p < 0.05), left ventricular posterior wall thickness was thinner (p < 0.05), left ventricular end-diastolic pressure was higher (p < 0.05) and left ventricular wall stress was lower (p < 0.05) than in 25 responders. In 19 patients receiving carvedilol, 5 non-responders showed higher levels of human atrial natriuretic peptide (p < 0.05) and brain natriuretic peptide (p < 0.01) than 13 responders. Discriminant analysis with a linear discriminant function showed the following equation predicted response to beta-blocker therapy: h = 0.004 × systolic blood pressure – 0.002 × brain natriuretic peptide + 0.667 (R2 = 0.67, p < 0.001). The probability of predicting the response was 94.1% with h ≧0.5. Conclusion: We conclude that h≧0.5 is the appropriate indication for the initiation of beta-blocker therapy in DCM.
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