Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a nonmalignant adenomatous overgrowth of the periurethral prostate gland commonly seen in aging men. Historically, it has been assumed that the pathophysiology of lower urinary tract symptoms in men is the result of bladder outlet obstruction associated with prostate enlargement. Symptoms such as urinary hesitancy, incomplete bladder emptying, dribbling or prolonged urination, nocturia, urinary urgency, and/or urge incontinence are common. Understanding the differential diagnosis and ordering appropriate laboratory tests are essential in accurately identifying a BPH diagnosis. Management can be broken down into medical or pharmacological and surgical therapies. This article aims to provide an overview of BPH and its management in older adults.
AE = Adverse events, AHA/ACC/TOS = American Heart Association/American College of Cardiology/ The Obesity Society, BMI = Body mass index, CV = Cardiovascular, FDA = Food and Drug Administration, GI = Gastrointestinal, GLP-1 = Glucagon-like peptide-1, HbA1c = Hemoglobin A1c, Kcal = Kilocalorie, LCD = Low-calorie diet, MTC = Medullary thyroid carcinoma, NHLBI = National Heart Lung and Blood Institute, NNH = Number needed to harm, PYE = Patient years of exposure, REMS = Risk Evaluation and Mitigation Strategy, SCALE™ = Satiety and Clinical Adiposity - Liraglutide Evidence in Non-diabetic and Diabetic individuals, T2DM = Type 2 diabetes mellitus.
Interleukin-1 (IL-1) inhibitors potentially have a role as antiinflammatory agents in refractory gout or for patients who are unable to tolerate conventional therapy, such as nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, or glucocorticoids, for acute attacks. Additionally, IL-1 inhibitors may also help patients with polyarticular and tophaceous gout by making them less vulnerable to breakthrough attacks during initiation of chronic urate-lowering treatment, the mainstay of gout therapy. Because evidence highlights the role of proinflammatory cytokine IL-1 in the inflammation process during an acute gouty attack, IL-1 inhibitors are used to modulate the pathogenesis of a variety of autoinflammatory diseases, providing support for its potential role in the inflammatory process of gout. After NSAIDs, colchicine, and steroids, IL-1 inhibitors are beneficial as fourth-line therapy for acute gout attacks due to their high cost and limited clinical experience. The IL-1 inhibitors used in gout are anakinra, canakinumab, and rilonacept. Based on published evidence, anakinra has limited support in the form of anecdotal case reports to justify its use for treating gout. Canakinumab's toxic profile in clinical trials precludes its use in treating patients for gout, and rilonacept shows promise with a few well-designed studies to support its use in gout patients initiating urate-lowering treatment. When combined with current traditional therapies, these newer agents present clinicians and patients with more potential treatment options in the difficult-to-treat gout population.
Introduction Mobile applications (apps) may improve adherence and disease state‐related outcomes in patients with uncontrolled chronic diseases, including hypertension. Objective The purpose of this study was to determine the effectiveness of using a pharmacist‐designed app to improve blood pressure (BP) and promote adherence to antihypertensive medications. Methods This study was a prospective, multicenter, randomized controlled trial. Patients were randomized to an intervention or control group for 3 months. The intervention was a pharmacist‐designed mobile app. Antihypertensive medication refill history was assessed 3 months before, during study, and 3 months after study completion. Continuous outcome measures investigated were systolic/diastolic BP and medication refill history using the cumulative medication gap (CMG). Statistical analysis comparing median difference in BPs and CMGs between groups was conducted using Theil‐Sen Siegel regression. Results The propensity score adjusted population consisted of 78 patients (n = 39 for both groups). No significant difference was observed in the conditional median difference in CMG between groups at the 3‐month follow‐up visit (−0.06 [P = .70]). No significant difference was observed in the conditional median difference in systolic and diastolic BP between groups at the 3‐month follow‐up visit (−2.00 [P = .07] and −1.00 mmHg [P = .39] systolic and diastolic, respectively). Upon subgroup analysis, those nonadherent at baseline in the intention to treat population experienced a significant improvement in outcomes (−0.06 P = .03] and −12.00 mmHg [P = .002] CMG and systolic BP, respectively). Conclusion A pharmacist‐designed mobile app did not result in improved medication adherence or BP control, but may be beneficial in patients with hypertension who struggle with medication adherence.
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