Atrial fibrillation is associated with cardiovascular events in obese Japanese with one or more cardiovascular risk factors: The Japan Morning Surge Home Blood Pressure (J‐HOP) Study

Objective: To evaluate the impact of pharmacists, working collaboratively with patients, on blood pressure control, lifestyle goal setting, adherence to antihypertensive therapy, patient knowledge and satisfaction, and modification of cardiovascular risk factors. Methods: Self-declared hypertensive patients met with the pharmacist for blood pressure monitoring, lifestyle goal setting, and education about medications and disease state on four occasions over a 6-month period. Practice innovation: A community pharmacy partnered with an employer wellness plan to provide education and monitoring for patients with hypertension based on home blood pressure readings obtained using monitors that wirelessly transmit information to the pharmacist. Main outcome measure(s): Percentage of patients at blood pressure goal, mean blood pressure, percentage of patients with lifestyle goals, medication adherence, patient knowledge and satisfaction, and modification of cardiovascular risk factors. Results: Patients not at their goal blood pressure at baseline had a significant decrease in blood pressure and a significant increase in achievement of their blood pressure goals. Across the population, no significant changes were seen in the primary outcome, lifestyle goals, medication adherence or modification of cardiovascular risk factors. Patient knowledge increased from baseline and satisfaction with the service was high. Conclusion: Blood pressure control improved in patients not at their treatment goal. All patients increased their knowledge about hypertension and reported high satisfaction with the pharmacy service. Pharmacy services should be offered to patients who are more likely to reap a benefit. Home blood pressure readings are useful to inform clinical decision making and supplement patient consultation within the pharmacy setting. Type: Original Research

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Effect of testosterone therapy on cardiovascular risk factors, major adverse cardiovascular events and mortality in men with functional hypogonadism and cardiovascular disease in a real-world registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.3221 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F Saad ◽

A Haider ◽

K.S Haider ◽

G Doros ◽

A.M Traish

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Real World ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events ◽

Funding Source ◽

Testosterone Therapy

Abstract Background Cardiovascular safety of testosterone therapy (TTh) in men with functional hypogonadism has been debated. Purpose To investigate cardiovascular risk factors and incidence of major adverse cardiovascular events (MACE) and mortality in a high-risk population in a real-world setting. Methods Of 773 men with functional (non-organic) hypogonadism in a registry study, 217 had a pre-existing cardiovascular disease. 99 men received parenteral TU 1000 mg/12 weeks following an initial 6-week interval (T-group) for up to 15 years, 118 opted against TTh and served as controls (CTRL). Most measurements were performed 2–4 times a year for approximately 1,800 patient-years. 11-year data were analysed. Changes over time between groups were compared and adjusted for age, weight, waist circumference, fasting glucose, blood pressure, lipids and quality of life to account for baseline differences between the two groups. Results Mean baseline age: 61.5±4.6 years (T-group), 63.9±4.9 (CTRL) (p<0.0005). 86.9% in the T-group and 61.9% in CTRL (p<0.0001) were obese at baseline. Mean BMI (kg/m2) declined by 8.3±0.4 in the T-group and increased by 2.5±0.4 in CTRL at 11 years, estimated adjusted difference between groups: −10.8 (p<0.0001 for all). Weight loss was 20.8±0.6% (T-group), weight gain 8.1±0.5% (CTRL), difference between groups: −28.8% (p<0.0001 for all). 99% in the T-group and 97.5% in CTRL (p<0.001) had hypertension at baseline. Mean systolic blood pressure (BP) (mmHg) decreased by 36.2±1.3 (T-group) and increased by 9.3±1.3 (CTRL), difference between groups: −45.5 (p<0.0001 for all). Diastolic BP decreased by 24.0±1.0 (T-group) and increased by 7.7±1.0 (CTRL), difference between groups: −31.7 (p<0.0001 for all). Lipids (mmol/L): LDL cholesterol decreased by 2.1±0.1 (T-group) and increased by 0.9±0.1 (CTRL), difference between groups: −3.0 (p<0.0001 for all). Non-HDL cholesterol decreased by 5.7±0.4 (T-group) and increased by 4.8±0.4 (CTRL), difference between groups: −10.5 (p<0.0001 for all). Remnant cholesterol decreased by 1.2±0.1 (T-group) and increased by 1.0±0.1 (CTRL), difference between groups: −2.2 (p<0.0001 for all). 67.7% in the T-group and 55.1% in CTRL (NS) had type 2 diabetes (T2DM) at baseline. HbA1c (%) decreased by 3.4±0.2 (T-group) and increased by 2.7±0.2 (CTRL), difference between groups: −6.0 (p<0.0001 for all). 29 men (24.6%) were diagnosed with T2DM during follow-up. Mortality: 13 deaths (13.1%) in the T-group. 40 (33.9%) in CTRL (p<0.0005). Non-fatal myocardial infarctions: None in the T-group, 31 (26.3%) in CTRL (py0.0001). Non-fatal strokes: None in the T-group, 29 (24.6%) in CTRL (p<0.0001). Medication adherence to testosterone was 100% as all injections were administered in the medical office and documented. Conclusions In men with functional hypogonadism, long-term TTh improves cardiovascular risk factors and reduces cardiovascular events and mortality. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bayer AG

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