scholarly journals Farmaci antipertensivi a confronto: costi e benefici per il paziente e la collettività

2003 ◽  
Vol 4 (4) ◽  
pp. 193-200
Author(s):  
Francesco Vittorio Costa
Keyword(s):  
Pharmacoeconomic Analysis ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Retail Price ◽  
Life Saving ◽  
Achieve Goal Blood Pressure ◽  
Source Of Information ◽  
Methodological Evaluation

Pharmacoeconomic analysis of antihypertensive treatment should be performed following a correct methodological evaluation and considering with accuracy both costs and benefits of different therapeutic options. Costs evaluation is frequently performed simply examining the retail price of drugs which represents only a part (usually no more than 50%) of cumulative costs of therapy. Controlled clinical trials are the main source of information about benefits of therapy, but probably, in many cases, they underestimate the benefits of treatment and are unable to differentiate the effects of different drugs because of a too short follow-up. Benefits should be calculated not only in terms of saved lives or prevented events, but also in terms of prevention-regression of target organ damage and of quality of life of patients. If analysis are performed correctly, more recent drugs, like ATII antagonists, even if they have a higher retail price, become highly costeffective thanks to their protective activity against events, and to unbeatable levels of compliance and persistence which are associated with treatment with these drugs. Comparison between old (cheaper) and newer (more expensive) drugs, and recommendations to start therapy with the cheaper drugs, are a nonsense since to achieve goal blood pressure combinations of more drugs are always necessary. Treatment of hypertension, if extended to all patients and performed aggressively, must be considered not only a life-saving, but also a money-saving tool.

scholarly journals Time to Progression Post-Induction Predicts Outcomes of Ixazomib Based Therapy for Relapsed/Refractory Myeloma: Real World Data from a Multi-Site Israeli Registry Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1972-1972
Author(s):  
Yael C Cohen ◽  
Hila Magen ◽  
Noa Lavi ◽  
Moshe E. Gatt ◽  
Evgeni Chubar ◽  
...  
Keyword(s):  
Research Funding ◽  
Overall Response Rate ◽  
Target Organ Damage ◽  
Progression Free Survival ◽  
Organ Damage ◽  
Real World Data ◽  
Free Survival ◽  
Grade 3 ◽  
Indolent Disease

Abstract Introduction Ixazomib is an orally available proteasome inhibitor, shown to be safe and efficacious in combination with lenalidomide and dexamethasone (IRd regimen) in patients with relapsed and refractory multiple myeloma (RRMM) with 1-3 prior lines, demonstrating a progression free survival (PFS) benefit which was similar across cytogenetic risk groups (Tourmaline-MM1 phase 3 trial). A European real world data analysis of an IRd named patient program (NPP) outcomes in Greece (n=35), UK (n=46) and Check republic (n=57) showed similar favorable outcomes (Terpos et al, Blood 2017 130:3087). We aimed to analyze outcomes of ixazomib combinations among a multi-site cohort in the Israeli Myeloma registry. Overall response rate (ORR) was classified according to IMWG criteria. Primary endpoint was PFS, secondary endpoints included ORR, overall survival (OS), safety and tolerability. Patients A total of 78 patients across 7 sites, who received at least one cycle of ixazomib combination between June 2013 and June 2018 for treatment of RRMM were retrospectively included. Median age was 68 (range: 38-90). Male/Female ratio was 42/36. ISS (rISS) I/II/II was 30%/42%/27% (25%/54%/15%). Patient received between 1 and 7 prior lines of therapy, 66% received ixazomib in 2nd line, 18% in 3rd line. Overall, 89% of patients had been exposed to PIs (bortezomib 86%) prior to IRd, 41% to IMiDs (thalidomide 28% lenalidomide 22% and pomalidomide 6%), and 35% had undergone autologous transplantation (ASCT). Induction treatment was mostly bortezomib based (85%), most frequently VCD (62%). FISH cytogenetics were available for 60 patients, 29 (48%) had high or intermediate risk aberrations (t(4:14) 12 pts, amp 1q21 12 pts, del17p 9 pts). Disease aggressiveness was classified by treating physician as indolent (rapid control to protect from target organ damage not required) vs aggressive (imminent target organ damage) in 63% vs 27%, respectively. 60 (77%) of the 78 patients received ixazomib via a named patient program, the rest via national or private healthcare provider. Results Median time of follow up from first ixazomib dose was 22 months (range: 1-39 months), and 54 months from diagnosis of myeloma. Treatment is ongoing in 44 (56%) patients with a median duration of 19 months (range: 1-29). Among patients who discontinued treatment, the median duration was 9 months (1-31). Ixazomib was combined with lenalidomide, pomalidomide, and daratumumab in 69%, 9% and 4%, respectively. Overall response rate was 88% - CR 10%, VGPR 36%, PR 42%. Progression free survival was 78% and 54% at 12 and 24 months, respectively (fig1a). A worse PFS was found with physician assessment of aggressive vs indolent disease (14.5 vs 25.9 months, p=0.001), and with post induction progression free period (PFS1) ≤ 24 months vs. >24 months (23.9 vs 31.5 months, p=0.038) (fig 1b); age >=65 trended towards a worse PFS (p=0.058). Poor cytogenetic risk, prior exposure to bortezomib, prior auto transplant, and number of prior lines of therapy did not affect PFS or ORR. OS from first ixazomib administration was 90% and 81% at 12 and 24 months, respectively; median OS was not reached (fig1a). Any (grade 3-4) toxicity considered by investigator as related to ixazomib was reported in 70% (18% grade 3-4), including neutropenia 14% (6%), anemia 19% (6%), thrombocytopenia 17% (5%), nausea and vomiting 17% (1%), DVT/PE 4% (1%), neutropenic infection 0 (4%), peripheral neuropathy 14% (3%), diarrhea 14% (3%), rash 10% (4%), pneumonia 5% (3%). There were no ixazomib related deaths. Dose reduction or discontinuation due to toxicity occurred in 28% and 12%, respectively. Conclusion Our data shows ixazomib-based combinations are efficacious and safe regimens for patients with RRMM, achieving ORR of 88%, at 2nd as well as later lines of therapy, regardless to cytogenetic risk. Over a median follow up of almost 2-years, 54% remained progression free at 24 months. An ixazomib based regimen may be particularly attractive for patients who remain progression free for more than 24 months after a bortezomib induction and for patients with a more indolent disease phenotype. Disclosures Cohen: Neopharm Israel: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Medisson Israel: Consultancy, Honoraria, Research Funding. Tadmor:NOVARTIS: Consultancy; PFIEZER: Consultancy; ABBVIE: Consultancy; JNJ: Consultancy; ROCHE: Research Funding.

Abstract 545: Modification Over Time of Pulse Wave Velocity Parallel to Changes in Both Office and 24h-ambulatory Peripheral BP as well as Aortic BP

Hypertension ◽  
2014 ◽  
Vol 64 (suppl_1) ◽  
Author(s):  
Anna Oliveras ◽  
Julián Segura ◽  
Carmen Suárez ◽  
Luis García-Ortiz ◽  
María Abad ◽  
...  
Keyword(s):  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Target Organ Damage ◽  
Measurement Techniques ◽  
Organ Damage ◽  
Applanation Tonometry ◽  
Target Organ ◽  
Over Time

Aim: to assess the relationship of changes in pulse wave velocity (PWV), a marker of target organ damage, with the variation in BP over time, as assessed by three different methods of measurement: office and 24h-ambulatory peripheral BP as well as aortic BP. Methods: Observational prospective study in hypertensive subjects with impaired glucose metabolism consecutively recruited from Spanish Hypertension Units. Aortic BP and carotid-femoral PWV were evaluated by radial applanation tonometry (Sphygmocor®) at baseline ( b ) and after 12 months of follow-up ( fu ). Peripheral BP measurements were also recorded at baseline and at 12 months follow-up: office BP was obtained as the average of triplicate measurements taken at 1 min-intervals after 5 min of seated rest, using validated oscillometric devices; 24h-ambulatory BP recordings were taken with a validated device (Spacelabs®-90207) at 20-minute intervals throughout both the self-reported awake and asleep periods. Clinical and anthropometric features were also recorded. PWV variation (Δ) over time was calculated as follows: Δ PWV= [(PWV fu - PWV b ) / PWV b ] x 100. BP variation over time was calculated with the same formula applied to BP values obtained with the different measurement techniques. Correlations (Spearman “Rho”) of Δ PWV and Δ BP were calculated. Results: n=209 patients; mean age: 61.8 ± 11.2 y; 39% (81 of 209) were female; 80% (167 of 209) had type 2 diabetes. Other risk factors: hypertension: 100%; dyslipidemia: 69% (144 of 209); smokers: 13% (28 of 209); body mass index: 30.9 ± 4.4 Kg/m 2 . Baseline office systolic/diastolic BP (mmHg): oSBP = 143 ± 20; oDBP = 82 ± 12. Follow-up office systolic/diastolic BP (mmHg): oSBP = 136 ± 20; oDBP = 79 ± 12. Baseline PWV: 10.01 ± 3.5 m/s. Follow-up PWV: 10.19 ± 3.21 m/s. Δ PWV correlated with: Δ oSBP (Rho=0.212; p=0.002), Δ 24h-SBP (Rho=0.254; p<0.001), Δ daytime-BP (Rho=0.232; p=0.001), Δ nighttime-BP (Rho=0.320; p<0.001) and Δ aortic-SBP (Rho=0.320; p<0.001). Conclusion: Modification over time of PWV, a marker of target organ damage, parallel to changes in systolic BP, both office and 24h-ambulatory peripheral BP variation as well as aortic BP variation, at 12 months of follow-up. Among them, aortic SBP and nighttime peripheral SBP both showed the best correlation.

scholarly journals Assessment of Target Organ Damage in the Evaluation and Follow-Up of Hypertensive Patients: Where Do We Stand?

2013 ◽  
Vol 15 (10) ◽  
pp. 742-747 ◽  
Author(s):  
Gadi Shlomai ◽  
Guido Grassi ◽  
Ehud Grossman ◽  
Giuseppe Mancia
Keyword(s):  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Hypertensive Patients

scholarly journals Nem alkoholos zsírmájbetegség – a 2016. évi közös EASL–EASD–EASO klinikai ajánlás fényében

2018 ◽  
Vol 159 (45) ◽  
pp. 1815-1830 ◽  
Author(s):  
Ákos Nádasdi ◽  
Anikó Somogyi ◽  
Péter Igaz ◽  
Gábor Firneisz
Keyword(s):  
Metabolic Disease ◽  
Liver Disease ◽  
Target Organ Damage ◽  
Developed Countries ◽  
Organ Damage ◽  
Alcoholic Fatty Liver ◽  
The Developed Countries ◽  
Alcoholic Fatty Liver Disease

Abstract: The non-alcoholic fatty liver disease (NAFLD) as a common metabolic disease affects nearly one third of the population in the developed countries. The significance of the NAFLD is due to its spectrum disease (simple steatosis → NASH [non-alcoholic steatohepatitis] ± fibrosis → cirrhosis → HCC [hepatocellular carcinome]) character; its association with obesity, type 2 diabetes mellitus (T2DM), dyslipidaemia, metabolic syndrome, insulin resistance; and its complications both as a consequence of the direct progression of the liver disease and also related to the additional target organ damage due to the progression of the metabolic disease (cardiovascular, renal). The clinical practice guideline jointly authored by 3 European professional societies (EASL–EASD–EASO) in 2016 offers a gap-filling, more united diagnostic, therapeutical and follow-up algorithm for the management of NAFLD. The authors of this article could only aim at highlighting the most important considerations and cite a few important literatures that became available only after the publication of the original article. Orv Hetil. 2018; 159(45): 1815–1830.

scholarly journals Surgical treatment of upper urinary tract obstruction in tuberculosis of the urinary system

2021 ◽  
Vol 14 (3) ◽  
pp. 142-149
Author(s):  
A.A. Volkov ◽  
◽  
N.V. Budnik ◽  
O.N. Zuban ◽  
◽  
...  
Keyword(s):  
Urinary Tract ◽  
Surgical Treatment ◽  
Urinary Tract Obstruction ◽  
Organ Damage ◽  
Renal Tissue ◽  
Upper Urinary Tract ◽  
Reconstructive Operations ◽  
Urinary Tuberculosis

Introduction. Currently, the basis for effective treatment of urinary tuberculosis (UT) is a combination of specific chemotherapy with reasonable surgical intervention and strict follow-up of the patient. Materials and methods. This literature review presents the evolution of methods of surgical treatment of renal and upper urinary tract tuberculosis over of 127 sources found for the review, 63 were selected. Results. Since UT is a very slowly progressive disease with minimal and imperceptible symptoms, often leading to irreversible organ damage, up to 75% of patients with this pathology undergo surgery. As follows from the results of recent studies, the emphasis of surgical treatment is increasingly shifting from ablative and organ-carrying techniques to reconstructive operations. Surgery for upper urinary tract tuberculosis continues to develop, but its results in advanced cases of destruction of renal tissue often remain unsatisfactory. Conclusions. The search for new methods of reconstructive interventions, the purpose of which is to preserve functioning renal-ureteral units and improve the quality of life of patients, remains relevant.

scholarly journals Factors Underlying Defaulting on Antihypertensive Treatment

2014 ◽  
Vol 40 (3) ◽  
pp. 24-27
Author(s):  
Nur Alam ◽  
MA Azhar ◽  
Abdul Wadud Chowdhury ◽  
KMN Sabah ◽  
Md. Rasul Amin
Keyword(s):  
Antihypertensive Treatment ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Medical Practitioners ◽  
Medical College ◽  
Major Target

The magnitude of hypertensive patient not continuing treatment is not well documented. But it is assumed that it could be worse and thereby would contribute significantly to mortality and morbidity. A study can produce awareness among all level of medical practitioners regarding the factors underlying defaulting on anti hypertensive treatment. To find out the factors underlying being defaulter of antihypertensive treatment and making future recommendation for remedy - were the main objectives of the present study It was a cross sectional study which was carried out in medical indoor & out patient department of Sir Salimullah Medical College & Mitford Hospital, (SSMC & MH) Dhaka on 100 patients selected by purposive sampling who were defaulters of anti hypertensive treatment. The main causes of becoming defaulters were lack of knowledge and misconception (40%) and financial constrain (32%). The complications of defaulters of antihypertensive treatment were enormous. Most of the patients (80%) suffered from major target organ damage like Stroke/TIA (35%), LVH/LVF/IHD (15%), Retinopathy (12%), Nephropathy (5%) and more than one organ damage (13%). Awareness both of physicians and public about hypertension and proper counseling with education and information about hypertension, rational use of medication and regular follow up will be helpful to avoid morbid complication. DOI: http://dx.doi.org/10.3329/bmj.v40i3.18670 Bangladesh Medical Journal 2011 Vol.40(3):24-27

scholarly journals Impact of Uric Acid on Hypertension Occurrence and Target Organ Damage: Insights From the STANISLAS Cohort With a 20-Year Follow-up

2020 ◽  
Vol 33 (9) ◽  
pp. 869-878 ◽  
Author(s):  
Mehmet Kanbay ◽  
Nicolas Girerd ◽  
Jean-Loup Machu ◽  
Erwan Bozec ◽  
Kevin Duarte ◽  
...  
Keyword(s):  
Uric Acid ◽  
Diastolic Dysfunction ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Urine Albumin ◽  
Increased Risk ◽  
Older Subjects

Abstract BACKGROUND Recent studies have shown that hyperuricemia may be associated with incident hypertension (HTN). We examined whether serum uric acid (SUA) is a predictor of HTN and target organ damage (TOD) 20 years later in initially healthy middle-aged individuals. METHODS Participants from the Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux (STANISLAS) a single-center familial longitudinal cohort study (961 initially healthy adults and 570 children) underwent clinical and laboratory measurements at baseline and after approximately 20 years. Blood pressure (BP: using ambulatory BP measurements), urine albumin-to-creatinine ratio, estimated glomerular filtration rate (eGFR), left ventricular hypertrophy (LVH), diastolic dysfunction, and carotid–femoral pulse wave velocity (PWV) were measured at the end of follow-up. RESULTS In the parent population, higher baseline or last SUA levels and higher change in SUA (ΔUA) were significantly associated with an increased risk of HTN development, even after adjusting for known HTN risk factors (all P &lt; 0.01). Higher baseline SUA was marginally associated with an increased risk of having high carotid–femoral PWV (P = 0.05). The association of SUA with BP increase was body mass index dependent (the increase in BP being greater in leaner subjects; interactionp &lt; 0.05), and the association of SUA with eGFR decline was age dependent (the decline in eGFR being greater in older subjects; interactionp &lt; 0.05). There was no significant association between SUA and diastolic dysfunction or LVH. In the whole population (i.e. including children), a significant association between SUA at baseline and the risk of HTN and higher carotid–femoral PWV was also found (both P &lt; 0.02). CONCLUSIONS Increased SUA is associated with the development of HTN and vascular/renal TOD in initially healthy midlife subjects.

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