A FOURIER Analysis for Evaluation of Evolocumab for Reducing Cardiovascular Events in Diabetic Patient - Dr Vivek Baliga

Hospitalization for Heart Failure and Death in patient with/without prior CVD in New Users of SGLT-2 inhibitors: a CVD-REAL Study

T2DM patients with CVD on sodium glucose co-transporter 2 inhibitor (SGLT-2i) have shown reduction in cardiovascular death and hospitalization for heart failure (HHF).

This study used clinical practice data from 2012-2016 and compared HHF and death in patient with/without prior CVD or heart failure in new users of SGLT-2i vs other glucose lowering drugs (oGLD).

HHF and deaths were collected via medical records, medical claims, electronic health and death records, and national register; Hazard ratio (HR) for HHF, death and the composite endpoint (HHF or death) was calculated as average.

Overall, 306,156 patients with >150,000 person year(PY) 100,947 PY for SGLT-2i; 89,208 PY for oGLD) and 950 new HHF events were analyzed.

SGLT-2i was associated with significant lower rates of HHF with/without prior CVD (HR 0.69;95% CI 0.59-0.80) compared with oGLD (HR 0.55, 95% CI 0.34-0.88).

Similarly, death and composite endpoint was significantly lower for SGLT-2i when compared to oGLD, irrespective of heart failure or CVD.

SGLT-2i was associated with significant reduction in HHF and death vs oGLD in both with/without prior CVD or heart failure patients, which shows the beneficial effect of SGLT-2i over broad range of patient population with T2DM.

Checking Your Blood Pressure The Right Way - Dr Vivek Baliga Advice

Many of you reading this blog have high blood pressure. If you don’t, then you are in that small category of people in India that do not suffer from the problem. 

Aptly called the ‘silent killer’, high blood pressure affects many individuals across India and carries a great deal of mortality and morbidity. If you have been diagnosed with high blood pressure, your doctor will prescribe for you certain medications that will not only help control the BP but will also reduce your chances of developing complications in the future. 

High blood pressure is associated with heart disease, stroke, kidney disease and eye disease in addition to a number of other medical problems. Making sure that you follow the right lifestyle changes such as salt reduction and regular exercise are paramount to achieving adequate control.

An important aspect of management of BP is monitoring it at home. Numerous BP measuring devices are now available on the market and are quite accurate when compared to what your doctor measures in their clinic. It is therefore advisable to own one of these machines at home if you have high blood pressure as they can be invaluable in times of need especially if you are calling the doctor for advice. 

However, there are certain aspects of checking the BP at home that you need to be aware of so that the reading you obtain is as accurate as possible. Here are some simple steps that can guide you on how to check your blood pressure correctly.

1. Don't drink a caffeinated beverage or smoke for at least 30 minutes before the test. Doing so can affect the BP recordings.

2. Sit quietly for five minutes before the test begins. If possible, do not talk to anyone and just close your eyes and concentrate on your breathing.

3. During the measurement, sit in a comfortable chair with your feet on the floor and your arm supported so your elbow is at about the level of your heart.

4. The inflatable part of the cuff should cover at least 80% of your upper arm, and the cuff should be placed directly on the skin, not over any clothing. Make sure that the tubing that accompanies the cuff is placed over the inner aspect of the forearm so that it falls upon the brachial artery. The BP that is recorded is that of the brachial artery.

5. Don't talk during the measurement. When the machine is inflating the cuff, do not look at the readings as this can sometimes cause a slight amount of stress. This can falsely increase the BP which could get you even more stressed!

6. Have your blood pressure measured twice, with a brief break in between. It is recommended that you wait around 10 minutes before the next reading. If the readings are different by 5 points or more, have it done a third time. If you wish to, you may take an average of the three readings.

When recording the BP at home, it is important to bear in mind that there will be a slight difference between the machine readings and one which your doctor gets in the clinic. 

Currently, this is a well-known fact by the medical authorities and it is often assumed that a small difference between the manual readings and the machine readings is acceptable. 

In fact, a difference of about 10 mmHg either way would be regarded as acceptable. If you find that multiple readings that have been taken over a space of time are always elevated, it is advisable to contact your doctor to get further advice.

It is not uncommon for BP recordings to fluctuate throughout the day. BP readings may be high prior to taking medicines and may settle after taking medicines. 

There is no clear guideline as to when to check the BP but we often tell our patients to check it at least two hours after they have taken their medicines. 

This way, we can assess whether the medicines that have been prescribed are working effectively or not. If the BP readings at home taken at the suggested times match the BP readings that are obtained in the clinic, then it is safe to assume that the medicines are working effectively and that no further adjustments are required or necessary.

Try and maintain a diary of your BP either on your phone or in a scribble pad. Use this diary to also record your day-to-day activities and dietary patterns. 

Show this to your doctor every time you visit them. It will help guide them on further management. Use an approved device that has a good reputation and review online.