ABCD
: Appropriate Blood pressure Control in Diabetes
ABI
: ankle–brachial index
ABPM
: ambulatory blood pressure monitoring
ACCESS
: Acute Candesartan Cilexetil Therapy in Stroke Survival
ACCOMPLISH
: Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension
ACCORD
: Action to Control Cardiovascular Risk in Diabetes
ACE
: angiotensin-converting enzyme
ACTIVE I
: Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events
ADVANCE
: Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation
AHEAD
: Action for HEAlth in Diabetes
ALLHAT
: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack
ALTITUDE
: ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints
ANTIPAF
: ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation
APOLLO
: A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People
ARB
: angiotensin receptor blocker
ARIC
: Atherosclerosis Risk In Communities
ARR
: aldosterone renin ratio
ASCOT
: Anglo-Scandinavian Cardiac Outcomes Trial
ASCOT-LLA
: Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm
ASTRAL
: Angioplasty and STenting for Renal Artery Lesions
A-V
: atrioventricular
BB
: beta-blocker
BMI
: body mass index
BP
: blood pressure
BSA
: body surface area
CA
: calcium antagonist
CABG
: coronary artery bypass graft
CAPPP
: CAPtopril Prevention Project
CAPRAF
: CAndesartan in the Prevention of Relapsing Atrial Fibrillation
CHD
: coronary heart disease
CHHIPS
: Controlling Hypertension and Hypertension Immediately Post-Stroke
CKD
: chronic kidney disease
CKD-EPI
: Chronic Kidney Disease—EPIdemiology collaboration
CONVINCE
: Controlled ONset Verapamil INvestigation of CV Endpoints
CT
: computed tomography
CV
: cardiovascular
CVD
: cardiovascular disease
D
: diuretic
DASH
: Dietary Approaches to Stop Hypertension
DBP
: diastolic blood pressure
DCCT
: Diabetes Control and Complications Study
DIRECT
: DIabetic REtinopathy Candesartan Trials
DM
: diabetes mellitus
DPP-4
: dipeptidyl peptidase 4
EAS
: European Atherosclerosis Society
EASD
: European Association for the Study of Diabetes
ECG
: electrocardiogram
EF
: ejection fraction
eGFR
: estimated glomerular filtration rate
ELSA
: European Lacidipine Study on Atherosclerosis
ESC
: European Society of Cardiology
ESH
: European Society of Hypertension
ESRD
: end-stage renal disease
EXPLOR
: Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination
FDA
: U.S. Food and Drug Administration
FEVER
: Felodipine EVent Reduction study
GISSI-AF
: Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation
HbA1c
: glycated haemoglobin
HBPM
: home blood pressure monitoring
HOPE
: Heart Outcomes Prevention Evaluation
HOT
: Hypertension Optimal Treatment
HRT
: hormone replacement therapy
HT
: hypertension
HYVET
: HYpertension in the Very Elderly Trial
IMT
: intima-media thickness
I-PRESERVE
: Irbesartan in Heart Failure with Preserved Systolic Function
INTERHEART
: Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries
INVEST
: INternational VErapamil SR/T Trandolapril
ISH
: Isolated systolic hypertension
JNC
: Joint National Committee
JUPITER
: Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin
LAVi
: left atrial volume index
LIFE
: Losartan Intervention For Endpoint Reduction in Hypertensives
LV
: left ventricle/left ventricular
LVH
: left ventricular hypertrophy
LVM
: left ventricular mass
MDRD
: Modification of Diet in Renal Disease
MRFIT
: Multiple Risk Factor Intervention Trial
MRI
: magnetic resonance imaging
NORDIL
: The Nordic Diltiazem Intervention study
OC
: oral contraceptive
OD
: organ damage
ONTARGET
: ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial
PAD
: peripheral artery disease
PATHS
: Prevention And Treatment of Hypertension Study
PCI
: percutaneous coronary intervention
PPAR
: peroxisome proliferator-activated receptor
PREVEND
: Prevention of REnal and Vascular ENdstage Disease
PROFESS
: Prevention Regimen for Effectively Avoiding Secondary Strokes
PROGRESS
: Perindopril Protection Against Recurrent Stroke Study
PWV
: pulse wave velocity
QALY
: Quality adjusted life years
RAA
: renin-angiotensin-aldosterone
RAS
: renin-angiotensin system
RCT
: randomized controlled trials
RF
: risk factor
ROADMAP
: Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention
SBP
: systolic blood pressure
SCAST
: Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke
SCOPE
: Study on COgnition and Prognosis in the Elderly
SCORE
: Systematic COronary Risk Evaluation
SHEP
: Systolic Hypertension in the Elderly Program
STOP
: Swedish Trials in Old Patients with Hypertension
STOP-2
: The second Swedish Trial in Old Patients with Hypertension
SYSTCHINA
: SYSTolic Hypertension in the Elderly: Chinese trial
SYSTEUR
: SYSTolic Hypertension in Europe
TIA
: transient ischaemic attack
TOHP
: Trials Of Hypertension Prevention
TRANSCEND
: Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease
UKPDS
: United Kingdom Prospective Diabetes Study
VADT
: Veterans' Affairs Diabetes Trial
VALUE
: Valsartan Antihypertensive Long-term Use Evaluation
WHO
: World Health Organization

### 1.1 Principles

The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

/pdf/2013-esh-esc-guidelines-for-the-management-of-arterial-4ydvs5ifsx.pdf

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

https://caltcm.memberclicks.net/assets/documents/acc_aha_chf_2013_guidelines.pdf

2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Although considerable improvement has occurred in the process of care for patients with ST-elevation myocardial infarction (STEMI), room for improvement exists.[1–3][1][][2][][3] The purpose of the present guideline is to focus on the numerous advances in the diagnosis and management of patients

/pdf/acc-aha-guidelines-for-the-management-of-patients-with-st-3d4n2zt04k.pdf

ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)

Perioperative β-Blockade: Still Not Enough for Adequate Cardioprotection!

PATIENTS undergoing noncardiac surgery are at risk of adverse perioperative and long-term outcome. For example, data from the PeriOperative Ischemic Evaluation trial (POISE), which enrolled 8,351 patients undergoing noncardiac surgery, showed a perioperative mortality rate of 2.7%, 1.6% had a cardiovascular death, whereas nonfatal myocardial infarction (MI) was observed in another 4.4% subjects. The report by Ausset et al. in this issue of ANESTHESIOLOGY confirms this high risk of postoperative complications. When considering a patient for noncardiac surgery, a careful preoperative clinical risk evaluation and subsequent risk-reduction strategies are essential to reduce postoperative complications. To assist physicians with decision-making, clinical guidelines are developed. The aim of clinical guidelines is to improve patient care by providing recommendations about appropriate health care in specific circumstances. Development of clinical guidelines is an important component in improving quality of care. By translating the best available scientific evidence into specific recommendations, guidelines can serve as useful tools to achieve effective and efficient patient care. Additionally, successful perioperative evaluation and management of patients undergoing noncardiac surgery require careful teamwork and communication among all involved healthcare professionals. In 2009, the first European Society of Cardiology guidelines on perioperative care were developed. This decision-making process integrates clinical markers, early coronary evaluation, functional capacity, and the type of surgery involved. Ausset et al. examined the impact of a quality improvement program in practice on the incidence of perioperative MI (PMI) detected by serial measurements of troponin and long-term cardiac outcome. For this study, a total of 378 surgical procedures were included before (P1) and after quality enhancement (P2). The strength of this manuscript is the quality improvement program with a focus on multiple interventions instead of a single component. Their main results revealed a high incidence of 5.5% PMI with troponin release in the first 3 days after major orthopedic surgery. This type of surgery is categorized as intermediate-risk surgery in the European Society of Cardiology perioperative guidelines. The high incidence of PMI is in line with earlier research showing a 30-day incidence of troponin release of 6.9% in 1,066 intermediate noncardiac surgery procedures. On the other hand, in vascular surgery patients, which are recognized as high-risk surgery, perioperative troponin is demonstrated to be as high as 20%. These numbers underline the high cardiac risk of patients undergoing noncardiac surgery and the importance of careful perioperative risk management in these patients. In their study, Ausset et al. improved the quality of care with a relatively simple program. The protocol addressing issues such as hypovolemia, hypoxemia, and hyperglycemia was approved by and repeatedly explained to the staff and accessible in the operating rooms and the hospital electronic network. In our opinion, the addition of web-based patient management tools would be an ideal extra tool to assist physicians with providing decision support and collecting data. Quality of postoperative care was improved in different aspects. They report a tighter patient monitoring, with more patients receiving oxygen, insulin, and blood transfusion. Surprisingly, prescription of cardiovascular medication was not increased in P2, indicating room for further improvement. In our opinion, the improvement of quality care observed in the study of Ausset et al. is an important step in the improvement of contemporary care of noncardiac surgery patients. Unfortunately, they did not provide information on the performed or prescribed indicators in patients who had an indication for the specific quality of care indicator. This would give, besides the improvement of overall management, more insight in current status of evidence-based clinical practice. Importantly, improvement of postoperative care resulted in a decrease of both early and late major cardiac events in the study of Ausset et al. Incidences of PMI and major adverse cardiac events were 8.9% versus 3.9% (P 0.04) and 8.1% versus 1.9 (P 0.004) for P1 and P2, respectively. Furthermore, the occurrence of PMI with troponin release was correlated with poor long-term cardiac outcome. These data suggest that improving long-term outcome can be achieved by targeting PMI. There has to be some caution when interpreting these results. First, the study was not a randomized controlled trial,

Closing the Gap between Guidelines and Practice in Perioperative Care

Response to comment on: “perioperative blood glucose monitoring and control in major vascular surgery patients”

Le controle glycemique est peut etre un facteur de risque sous-estime chez les malades diabetiques ayant une arteriopathie peripherique (AP). Un traitement au long cours par statines peut ameliorer le controle glycemique et l'evolution de ces malades. Dans une etude observationnelle de cohorte de 425 malades diabetiques consecutifs ayant une AP, le traitement au long cours par statines a ete note, l'indice cheville-bras a ete mesure et des mesures repetees d'hemoglobine glyquee (HbA1c) realisees. Au cours du suivi (mediane 7 ans), la mortalite de toutes causes et la mortalite cardiaque sont survenues respectivement dans 37% et 22% des cas. Les diminutions de l'HbA1c et la variabilite de l'HbA1c ont predit independamment l'evolution en plus des valeurs de base de l'indice cheville-bras. Les malades sous traitement chronique par statines avaient davantage de chance d'avoir des HbA1c diminuees (risque relatif (RR) = 1,86, intervalle de confiance (IC) a 95% = 1,27-2,74 et des valeurs d'HbA1c inferieures a 7% (RR = 2,58, IC 95% = 1,49-4,48) au cours du suivi. Les statines etaient egalement associees de facon significative avec une mortalite de toutes causes plus faible (RR = 0,39, IC 95% = 0,26-0,61) et un taux de deces cardiaque plus faible (RR = 0,40, IC 95% = 0,24-76). D'apres les resultats de la presente etude observationnelle, nous concluons que des mesures repetees de l'HbA1c peuvent ameliorer la stratification des risques chez les malades diabetiques ayant une AP. De plus, le traitement par statines est associe a un meilleur controle glycemique et a de meilleurs resultats a long terme.

Don Poldermans

Papers

Perioperative β-Blockade: Still Not Enough for Adequate Cardioprotection!

Closing the Gap between Guidelines and Practice in Perioperative Care

Response to comment on: “perioperative blood glucose monitoring and control in major vascular surgery patients”

Contrôle glycémique, traitement hypolipémiant et pronostic des malades diabétiques ayant des lésions athéroscléreuses périphériques