PubMed · 15126929
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Brian N C Prichard, Patrick Vallance. 2004. ESH/ESC guidelines.. https://doi.org/10.1097/00004872-200404000-00030
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Hypertension and lipid disorders in type II diabetes contribute to increased coronary risk, but optimal drug therapy has not been defined. We investigated primary care physicians choices of antihypertensive and lipid-lowering therapy for subjects with type II diabetes diagnosed with hypertension. Subjects were registered with 105 UK general practices in the General Practice Research Database and prescribed oral hypoglycaemic drugs for the first time between January 1993 and December 2001. We evaluated prescriptions for antihypertensive drugs in subjects with secondary diagnoses of hypertension in the first year following initiation of oral hypoglycaemic therapy. Data were analysed for 4519 diabetic subjects with diagnosed hypertension. Between 1993 and 2001, the proportion prescribed thiazide diuretics increased from 20 to 30%; angiotensin-converting enzyme (ACE) inhibitors from 35 to 45% and angiotensin receptor blockers from 0 to 8%. The proportion of subjects prescribed lipid-lowering therapy increased from 8% in 1993 to 33% in 2001, with the proportion prescribed statins increasing from 1 to 30%. At different general practices, the proportion prescribed thiazide diuretics ranged from 0 to 52%, beta-blockers from 5 to 60%, ACE inhibitors from 15 to 81%, and statins from 0 to 50%. Variation between practices was not explained by adjusting for age, sex, prevalent coronary heart disease or study year. Trends in drug utilisation were consistent with the evolving evidence base but there were wide variations in drug utilisation between practices. A more consistent approach to drug selection might be associated with improved patient outcomes.
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BACKGROUND: Previous studies have shown that post-cardiothoracic surgery atrial fibrillation (AF) increases the risk of hospital length of stay (LOS), overall mortality, pulmonary edema, and need for a balloon pump. A meta-analysis of 2 previous trials showed a nonsignificant reduction in LOS with postoperative beta-blockers but only encompassed 1200 patients, with few valve surgery patients, and neither study used a hospital within the US. OBJECTIVE: To evaluate the impact of postoperative beta-blockers on LOS and AF. Secondary endpoints of overall mortality, pulmonary edema, and need for an intra-aortic balloon pump (IABP) were also evaluated between groups. METHODS: This was a prospective cohort evaluation of all patients undergoing cardiothoracic surgery at our institution between October 1999 and October 2003. Patients receiving prophylactic postoperative beta-blockers were matched (1:1) with patients not receiving prophylaxis for age >70 years, valvular surgery, history of AF, gender, and use of preoperative digoxin and beta-blockers. RESULTS: Patients (n = 1660) receiving postoperative beta-blockade had a reduction in LOS (mean +/- SD 10.22 +/- 11.38 vs 12.40 +/- 15.67; p = 0.001) and AF (23.5% vs 28.4%; p = 0.02). Mortality, pulmonary edema, and need for IABP were reduced by >50% (p < 0.001; p = 0.001; p < 0.001, respectively), while myocardial infarction and stroke were not significantly impacted. CONCLUSIONS: In this observational cohort study, prophylactic postoperative beta-blocker use was associated with shorter hospital LOS by an average of 2.2 days and a 17.3% lower incidence of AF. It may also be associated with reductions in overall mortality, pulmonary edema, and need for an IABP.