Why are perindopril and indapamide the preferred anti-hypertensives for patients with stroke/TIA?
Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack (PROGRESS)
PROGRESS Collaborative Group. The Lancet (September 2001)
Bottom line: The PROGRESS study aimed to assess the efficacy and safety of a blood-pressure-lowering regimen in individuals with a history of stroke or transient ischaemic attack, regardless of their hypertension status. A total of 6105 participants from 172 centers in Asia, Australasia, and Europe were randomly assigned to active treatment or placebo. The active treatment included perindopril 4 mg daily with the optional addition of indapamide at the discretion of treating physicians. The primary outcome was stroke. Over a 4-year follow-up, the active treatment significantly reduced blood pressure by 9/4 mm Hg and led to a 28% relative risk reduction in total stroke incidence compared to the placebo group ([95% Cl 17–38], p<0·0001). These findings suggest that these agents should be considered routinely for individuals with a history of stroke or transient ischaemic attack, irrespective of their blood pressure levels.
What’s the rationale for treating iron deficiency with IV iron in patients with HFrEF ?
Ferric Carboxymaltose in Patients with Heart Failure and Iron Deficiency
Anker S et al. NEJM (December 2009)
Bottom Line: This study investigated the impact of intravenous iron treatment (ferric carboxymaltose) on patients with chronic heart failure, reduced left ventricular ejection fraction, and iron deficiency (ferritin level <100 μg per liter or between 100 and 299 μg per liter, if the transferrin saturation was <20%) with or without anemia. 459 participants were randomly assigned to receive either ferric carboxymaltose 200 mg IV or saline placebo. Primary end points were the self-reported Patient Global Assessment and NYHA functional class at week 24 and secondary end points included distance walked in 6 minutes and the health-related quality of life. 50% of those receiving ferric carboxymaltose reported being much or moderately improved according to the Patient Global Assessment, compared to 28% in the placebo group (odds ratio for improvement, 2.51; 95% confidence interval [CI], 1.75 to 3.61). 47% of the active treatment group had an NYHA functional class I or II at week 24 compared to 30% of the placebo group (odds ratio for improvement by one class, 2.40; 95% CI, 1.55 to 3.71). Additionally, significant improvements were seen in secondary end points in the treatment group with similar rates of death, adverse events, and serious adverse events in the two study groups.
LINK TO ARTICLE (Anker et al.)
What evidence supports a short course of antibiotics for patients with intra-abdominal infection?
Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection
Sawyer R et al. NEJM (May 2015)
Bottom Line: This study aimed to determine the optimal duration of antibiotic therapy for complicated intraabdominal infections with adequate source control. 518 patients were randomly assigned to receive either a fixed 4±1 day course of antibiotics (experimental group) or antibiotics until 2 days after resolution of specific physiological markers (fever, leukocytosis, and ileus), to a maximum of 10 days (control group). The primary outcome was a composite of surgical-site infection, recurrent intraabdominal infection, or death within 30 days after the index source-control procedure and secondary outcomes included duration of therapy and rates of subsequent infections. There was no significant difference in composite primary outcome events in the experimental group (56/257 patients, 21.8%) versus the control group (58/260 patients, 22.3%) (95% confidence interval [CI], −7.0 to 8.0; P=0.92). However, the experimental group had a significantly shorter median duration of antibiotic therapy (4.0 days) compared to the control group (8.0 days).
LINK TO ARTICLE (Sawyer et al.)
