William Cushman, MD

69 posts

William Cushman, MD

William Cushman, MD

@wccushman

Memphis, TN Katılım Ağustos 2016
6 Takip Edilen84 Takipçiler
William Cushman, MD
William Cushman, MD@wccushman·
@georgehret @HyperAHA #HYPHIP A11: Yes, there were other trials ongoing or just completed looking at CV outcomes with lower SBP goals, e.g., ACCORD BP and SPS3. The ACCORD BP standard glycemia group had similar CVD benefit with SBP <120 as was seen in SPRINT.
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William Cushman, MD
William Cushman, MD@wccushman·
@NakagawaPablo @HyperAHA #HYPHIP A11 2/2: also if the 3-4 classes weren't sufficient, we recommended adding spironolactone or amiloride if not contraindicated. Other classes that can be added include alpha blockers, direct vasodilators, or another CCB (e.g., copmbine a DHP and on-DHP if not on BB).
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William Cushman, MD
William Cushman, MD@wccushman·
@NakagawaPablo @HyperAHA #HYPHIP A11 1/2: We included some patients with resistant HTN in #SPRINT - they have been reported to have the same CVD benefits in SPRINT. I would refer you to position papers, etc., on managing and evaluating resistant HTN, but see my previous answer about adding meds in SPRINT
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William Cushman, MD
William Cushman, MD@wccushman·
@NakagawaPablo @HyperAHA #HYPHIP A10 1/2: The most common regimens included a thiazide-type diuretic and an ACEI or ARB, but one of these with a CCB are also good - in Blacks a CCB and a thiazide-type diuretic makes sense. If amy 2 are not enough, then we recommended adding the 3rd of these.
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William Cushman, MD
William Cushman, MD@wccushman·
@georgehret @HyperAHA #HYPHIP A9 3/3: Also we looked at those with lowest DBP at baseline - as usually seen they were at higher risk, but benefitted as much from the intensive SBP goal treatment.
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William Cushman, MD
William Cushman, MD@wccushman·
@georgehret @HyperAHA #HYPHIP A9 2/2: Benefit included older (>75 yrs) and "frail" but remember we excluded those in nursing homes, with dementia, or with limited life expectancy. Improtant from our article to consider drug classes mostly used.
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William Cushman, MD
William Cushman, MD@wccushman·
@georgehret @HyperAHA #HYPHIP A9 1/2: Intensive treatment can increase some side effects, but very low incidence and seemed easily manageable and corrected. The benefits of the lower goal exceeded the small incidence if a few AEs,
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William Cushman, MD
William Cushman, MD@wccushman·
@georgehret @HyperAHA #HYPHIP A8 3/3: This technique is similar to what almost all recent guidelines recommend and generally how done in all major outcome studies in HTN, although earlier studies used Hg manometers.
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William Cushman, MD
William Cushman, MD@wccushman·
@georgehret @HyperAHA #HYPHIP A8 2/3: When start button was pushed, machine waited 5 min, took and averaged 3 measurements. Staff could be in the room or leaving patients alone in the room (same results).
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William Cushman, MD
William Cushman, MD@wccushman·
@georgehret @HyperAHA #HYPHIP A8. 1/2: Very important! BP was measured with a fully automated device (Omron 907XL) – participants were seated in chair with back supported, proper cuff size, no talking/quiet for rest and measurements.
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William Cushman, MD
William Cushman, MD@wccushman·
@georgehret The nurses were quite knowledgeablwe avbout HTN management, but there was no special training for "motivational intervention". Participants seemed very adherent, however, based on pill counts, compliance Qs, and BP responses.
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Georg Ehret, MD FESC FAHA
Georg Ehret, MD FESC FAHA@georgehret·
This is interesting: good communication early greatly helps with BP control. Q8: Was there a role for motivational intervention by nurses in the #SPRINT trial ? #HYPHIP
William Cushman, MD@wccushman

@DrDudenbostel @georgehret @HyperAHA #HYPHIP A5: Yes, I start the first visit explaining that mmore than 50% of HTN patients need at least 3 drughs to control BP, but we can often keep the regimen simple and most tolerate these drugs well. Combinations and long-acting drugs can limit # of pills.

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William Cushman, MD
William Cushman, MD@wccushman·
@georgehret #HYPHIP A7: I'm not sure what the Q is, but home BP monitoring can be very helpful, especially in titrating or adding drugs between visits and to take into account, but I primarily rely on properly measured clinic visits as we did in #SPRINT.
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Georg Ehret, MD FESC FAHA
Georg Ehret, MD FESC FAHA@georgehret·
Welcome to Fausto! Let's make this Q7: what I do with my patients. first 7 days of HTA control I ask to perform a Home Monitoring 3 times a day and to report and write me down in a notebook for control and instructions. Then if every week until the 1st month. #HYPHIP @wccushman
fausto heredia z.@drfherediaz

@HyperAHA @georgehret @wccushman En las Conclusiones permitame opinar lo que hago con mis pacientes. Los 7 primeros dias del control de la HTA pido se realicen un Monitoreo en Casa 3 veces al dia y que me reporten y anoten en un cuaderno para control y dar instrucciones. Luego si cada semana hasta el 1er mes.

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Guto Montezano
Guto Montezano@guto_montezano·
Q6 @wccushman @georgehret #HYPHIP Would you explain to us whether sex and race differences influence the new SPRINT data? Also would these possible observations be accounted for change of practice in management of hypertension?
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William Cushman, MD
William Cushman, MD@wccushman·
@DrDudenbostel @georgehret @HyperAHA #HYPHIP A5: Yes, I start the first visit explaining that mmore than 50% of HTN patients need at least 3 drughs to control BP, but we can often keep the regimen simple and most tolerate these drugs well. Combinations and long-acting drugs can limit # of pills.
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William Cushman, MD
William Cushman, MD@wccushman·
@georgehret #HYPHIP A3b 2/2: and then drugs could be titrated up and other durgs could be added mostly from same classes (but not ACEI and ARB together), beta-blockers could be used, especially if indication.
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William Cushman, MD
William Cushman, MD@wccushman·
@georgehret #HYPHIP A3b: investigators could select among the clases of drugs with best outcome data, thiazide-type diuretics, ACE inhibitors or ARBs, and CCBs - intensive participatns were switched to at least 2 drugs on randomization.
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William Cushman, MD
William Cushman, MD@wccushman·
@georgehret @HyperAHA #HYPHIP Q4 2/2: The number of drugs in the <140 group was 1.9 and fell to 1.8 dugs on average, but likely more effective drugs/doses, since BP improved in the <140 group also.
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Keşfet

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