Heart failure poses an increasing problem for global health care systems.The epidemiological data which have been accrued over the last 30 years have predominantly been accumulated from experience within North America...Heart failure poses an increasing problem for global health care systems.The epidemiological data which have been accrued over the last 30 years have predominantly been accumulated from experience within North America and Europe.The European experience in heart failure,although similar to that in North America,has recently demonstrated differences in hospitalization which may underlie the differences between health care system confi gurations.Despite the predicted increase in the number of patients affected by heart failure,over the last 30 years a clear management algorithm has evolved for the use of pharmacotherapies,device-based therapies,and mechanical therapies,including left ventricular assist devices and cardiac transplantation.Although the treatment of such patients has been clearly delineated in national and international guidelines,the underuse of all available and appropriate therapies remains a signifi cant problem.The purpose of this review is to provide a European perspective on management of heart failure.展开更多
Resistant hypertension(RH) has a prevalence of around 12% and is associated with an increased risk of cardiovascular disease, progression to end-stage renal disease, and even mortality. In 2017, the American College o...Resistant hypertension(RH) has a prevalence of around 12% and is associated with an increased risk of cardiovascular disease, progression to end-stage renal disease, and even mortality. In 2017, the American College of Cardiology and American Heart Association released updated guidelines that detail steps to ensure proper diagnosis of RH, including the exclusion of pseudoresistance.Lifestyle modifications, such as low salt diet and physical exercise, remain at the forefront of optimizing blood pressure control. Secondary causes of RH also need to be investigated, including screening for obstructive sleep apnea. Notably, the guidelines demonstrate a major change in medication management recommendations to include mineralocorticoid receptor antagonists. In addition to advances in medication optimization, there are several device-based therapies that have been showing efficacy in the treatment of RH. Renal denervation therapy has struggled to show efficacy for blood pressure control, but with a redesigned catheter device, it is once again being tested in clinical trials. Carotid baroreceptor activation therapy(BAT) via an implantable pulse generator has been shown to be effective in lowering blood pressure both acutely and in longterm follow up data, but there is some concern about the safety profile. Both a second-generation pulse generator and an endovascular implant are being tested in new clinical trials with hopes for improved safety profiles while maintaining therapeutic efficacy. Both renal denervation and carotid BAT need continued study before widespread clinical implementation. Central arteriovenous anastomosis has emerged as another possible therapy and is being actively explored. The ongoing pursuit of blood pressure control is a vital part of minimizing adverse patient outcomes. The future landscape appears hopeful for helping patients achieve blood pressure goals not only through the optimization of antihypertensive medications but also through device-based therapies in select individuals.展开更多
文摘Heart failure poses an increasing problem for global health care systems.The epidemiological data which have been accrued over the last 30 years have predominantly been accumulated from experience within North America and Europe.The European experience in heart failure,although similar to that in North America,has recently demonstrated differences in hospitalization which may underlie the differences between health care system confi gurations.Despite the predicted increase in the number of patients affected by heart failure,over the last 30 years a clear management algorithm has evolved for the use of pharmacotherapies,device-based therapies,and mechanical therapies,including left ventricular assist devices and cardiac transplantation.Although the treatment of such patients has been clearly delineated in national and international guidelines,the underuse of all available and appropriate therapies remains a signifi cant problem.The purpose of this review is to provide a European perspective on management of heart failure.
文摘Resistant hypertension(RH) has a prevalence of around 12% and is associated with an increased risk of cardiovascular disease, progression to end-stage renal disease, and even mortality. In 2017, the American College of Cardiology and American Heart Association released updated guidelines that detail steps to ensure proper diagnosis of RH, including the exclusion of pseudoresistance.Lifestyle modifications, such as low salt diet and physical exercise, remain at the forefront of optimizing blood pressure control. Secondary causes of RH also need to be investigated, including screening for obstructive sleep apnea. Notably, the guidelines demonstrate a major change in medication management recommendations to include mineralocorticoid receptor antagonists. In addition to advances in medication optimization, there are several device-based therapies that have been showing efficacy in the treatment of RH. Renal denervation therapy has struggled to show efficacy for blood pressure control, but with a redesigned catheter device, it is once again being tested in clinical trials. Carotid baroreceptor activation therapy(BAT) via an implantable pulse generator has been shown to be effective in lowering blood pressure both acutely and in longterm follow up data, but there is some concern about the safety profile. Both a second-generation pulse generator and an endovascular implant are being tested in new clinical trials with hopes for improved safety profiles while maintaining therapeutic efficacy. Both renal denervation and carotid BAT need continued study before widespread clinical implementation. Central arteriovenous anastomosis has emerged as another possible therapy and is being actively explored. The ongoing pursuit of blood pressure control is a vital part of minimizing adverse patient outcomes. The future landscape appears hopeful for helping patients achieve blood pressure goals not only through the optimization of antihypertensive medications but also through device-based therapies in select individuals.
