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On the basis of high-quality observational data, Goyal et al. have found that serum potassium levels <3.5 mmol/l or ≥4.5 mmol/l are associated with increased in-hospital mortality in patients with acute myocardial infarction. We discuss whether target potassium levels in clinical practice and guidelines should be changed to 3.5–4.5 mmol/l.
Dabigatran has been associated with an increase in acute coronary events when compared with warfarin in several randomized trials, and now in a meta-analysis by Uchino and Hernandez. We critically review the evidence for this association and consider the implications for patient care.
The balance of benefits and risks of aspirin in primary prevention is far less clear than in secondary prevention; further data from randomized trials of individuals at intermediate cardiovascular risk are needed. Decisions about aspirin in primary prevention should be made on a case-by-case basis, and general guidelines are not justified.
Efforts to improve health-care quality and efficiency will fail if patients with chronic disease do not adhere to medications and healthy lifestyles. A novel, psychological approach is to change behavior using 'affect' and 'affirmations'. We explore this strategy's potential, when added to the existing arsenal of interventions, to improve adherence.
Paravalvular aortic regurgitation (PAR) after transcatheter aortic valve replacement is common and independently associated with increased morbidity and mortality. The determinants of PAR are uncertain, but new data extend our understanding, and a simple practice change in preprocedural imaging could help dramatically to reduce the incidence of this important complication.
Elevated blood pressure (BP) is probably the most-important, modifiable risk factor for cardiovascular disease. Dr. Ruilope discusses current controversies and challenges in the treatment of patients with arterial hypertension, including the validity of office BP measurements, appropriateness of BP targets, use of combination therapy, and patient compliance.
Hypertension is the most prevalent controllable disease in the adult population of the developed world. Although various effective treatments are available, the development of novel therapies is still required. The authors review key advances in pharmacological and nonpharmacological therapies for hypertension in 2010–2011 and comment on possible future developments.
Hypertension is a highly prevalent modifiable risk factor for cardiovascular disease, which is particularly common among older adults. The elderly represent an important, although often overlooked, group of patients for whom assessment and treatment of hypertension requires special consideration. Comorbidities, multiple drug regimens, and potential causes of secondary hypertension can all affect the management of these individuals. Drs Pimenta and Oparil review the pathophysiology of hypertension in the elderly and how best to assess and treat these patients.
Echocardiographic screening for rheumatic heart disease (RHD) over the past 5 years has revealed a higher RHD disease burden than previously imagined and, globally, at least 15 million people are estimated to be affected by this disease. In this article, an international advisory group of experts in RHD screening and echocardiographic manifestations of RHD present the 2012 World Heart Federation criteria for echocardiographic diagnosis of RHD.
