Abstract:
:Overactivity of the renin-angiotensin-aldosterone system (RAAS) plays a key role in the pathophysiology of heart failure (HF) and chronic kidney disease (CKD). RAAS antagonists can significantly improve clinical outcomes, but monotherapy blocks but one step of the RAAS and can be bypassed through compensatory mechanisms. Providing more complete RAAS blockade by deploying drugs with complementary actions seemed logical - hence the practice of using dual (or triple) RAAS inhibitors. However, RAAS antagonists also exhibit dose-limiting side effects, including acute kidney injury, hyperkalaemia and hypotension, which blunt their overall effectiveness. Despite achieving better RAAS blockade, several trials failed to show clinical outcome improvements. Patients with concomitant CKD and HF (cardiorenal syndrome) are at the greatest risk of these adverse events and therefore the least able to benefit, yet they also have the worst prognosis. This paradox, where those most in need have fewest therapeutic options, poses three questions which are the focus of this review: whether (i) novel therapies that prevent adverse effects can restore therapeutic benefits to patients who would otherwise be RAAS-therapy intolerant, (ii) there are any validated alternatives to their use and (iii) newer approaches to the detection of fluid congestion are ready for implementation.
journal_name
Int J Clin Practjournal_title
International journal of clinical practiceauthors
Ziff OJ,Covic A,Goldsmith Ddoi
10.1111/ijcp.12803subject
Has Abstractpub_date
2016-07-01 00:00:00pages
537-53issue
7eissn
1368-5031issn
1742-1241journal_volume
70pub_type
杂志文章,评审abstract:BACKGROUND:It is undecided whether glucose control as advocated by the professional organisations and the glucose-lowering method by itself affects clinical outcome in patients with diabetes mellitus hospitalised in general medical wards. Our aim was to investigate whether a basal/bolus regimen and a modified prehospit...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/j.1742-1241.2010.02384.x
更新日期:2010-12-01 00:00:00
abstract::This trial assessed whether a simple clinical tool can be used to stratify patients with diabetes, according to risk of developing foot ulceration. This was a prospective, observational follow-up study of 3526 patients with diabetes (91% type 2 diabetes) attending for routine diabetes care. Mean age was 64.7 (range 15...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/j.1368-5031.2006.00899.x
更新日期:2006-05-01 00:00:00
abstract::A patent foramen ovale (PFO) has long been implicated as a potential mechanism for cryptogenic stroke (CS), which accounts for up to 40% of all cases of ischaemic stroke. Although there is a strong association between a PFO and CS, there is less evidence that percutaneous closure of the defect, as opposed to medical t...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:10.1111/ijcp.12312
更新日期:2014-05-01 00:00:00
abstract:AIMS/OBJECTIVES:In the BESIDE study, combination therapy (antimuscarinic [solifenacin] and β3 -adrenoceptor agonist [mirabegron]) improved efficacy over solifenacin monotherapy without exacerbating anticholinergic side effects in overactive bladder (OAB) patients; however, a potential synergistic effect on the cardiova...
journal_title:International journal of clinical practice
pub_type: 杂志文章,随机对照试验
doi:10.1111/ijcp.12944
更新日期:2017-05-01 00:00:00
abstract::Macrolide anti-bacterials are widely used for the empirical treatment of lower respiratory tract infections (RTIs) due to their activity against Streptococcus pneumoniae and other common respiratory pathogens and good safety/tolerability profile. However, the prevalence of macrolide resistance, particularly pneumococc...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1368-5031.2004.00152.x
更新日期:2004-08-01 00:00:00
abstract::Fever of unknown origin (FUO) is a clinical dilemma in western countries and in China. To investigate the causes and prognosis of FUO, 208 patients with FUO admitted to a large university hospital in China were investigated. The final diagnoses established in 158 cases (75.96%) were: infectious disease in 66 cases (31...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:
更新日期:2003-09-01 00:00:00
abstract:AIM:To evaluate whether administration of long-acting basal insulin analogue plus oral antidiabetic drugs (OADs) improves glycaemic control in type 2 diabetic patients with glycosylated haemoglobin (HbA1c) > 7% (53 mmol/mol) under premixed insulin therapy. METHODS:This is a multicentre, observational, retrospective st...
journal_title:International journal of clinical practice
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1742-1241.2012.03000.x
更新日期:2012-10-01 00:00:00
abstract:AIMS:This review aims at analysing the published literature on chemotherapy for hormone-refractory prostate cancer (HRPC) to provide recommendations for the treatment of this important patient group. METHODS:The information for this review was compiled using the PubMed and Medline databases and the Proceedings of the ...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1742-1241.2007.01551.x
更新日期:2007-12-01 00:00:00
abstract:INTRODUCTION:Peripartum cardiomyopathy (PPCM) is an uncommon form of congestive heart failure, afflicting obstetric patients around the time of delivery. The epidemiology of PPCM is infrequently reported. To the best of our knowledge, there has been no report from Asia. OBJECTIVE:To define the prevalence, presentation...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/j.1742-1241.2007.01449.x
更新日期:2009-05-01 00:00:00
abstract:OBJECTIVE:The purpose of this study is to compare the thyroid hormone (TH) profile in male infertile subjects with normal and altered sperm parameters and assess its relationship with spermogram and reproductive hormones. DESIGN:This cross-sectional study was conducted in Karachi from August 2017 till September 2018 o...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/ijcp.13555
更新日期:2020-09-01 00:00:00
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journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1368-5031.2006.00709.x
更新日期:2006-06-01 00:00:00
abstract::A press through package (PTP) is commonly used as a package for drugs and also being seen increasingly in cases of foreign body in the digestive tract. We presented three cases of inadvertent PTP ingestion with a variety of clinical presentations. Although commonly considered to be small and soft to cause bowel damage...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/j.1742-1241.2006.00766.x
更新日期:2006-02-01 00:00:00
abstract::The potential effect of orlistat on cardiovascular co-morbidities may have been previously underestimated. This study assesses the efficacy of orlistat therapy for weight loss and cardiovascular risk factor reduction in obese patients with cardiovascular risk. This was a 54-week, double-blind, randomised, placebo-cont...
journal_title:International journal of clinical practice
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:
更新日期:2002-09-01 00:00:00
abstract::Helicobacter pylori (Hp) eradication in peptic ulcer disease is associated with a greatly reduced recurrence rate. The optimal drug regimen for HP eradication remains uncertain. It is also unclear if eradication of Hp in duodenitis and antral gastritis improves symptoms. The aims of this study were to compare the effi...
journal_title:International journal of clinical practice
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1997-06-01 00:00:00
abstract::Overactive bladder (OAB) affects an estimated 49 million people in Europe, but only a minority receive appropriate treatment. Others are bothered by unacceptable levels of symptoms that severely impair their quality of life and represent a significant financial burden to themselves and to their healthcare providers. R...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1742-1241.2006.01127.x
更新日期:2006-10-01 00:00:00
abstract::An increasing number of patients aged>or=70 years are presenting for elective non-cardiac surgery. We undertook this study to: (i) compare the nature and distribution of cardiovascular disease (CVD) risk factors in an at risk population of patients aged>or=70 years undergoing elective surgery compared with a younger a...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/j.1742-1241.2007.01304.x
更新日期:2007-05-01 00:00:00
abstract:BACKGROUND:Ultrasonography is increasingly used by clinicians to identify abdominal aortic aneurysms (AAA). We performed a systematic review and meta-analysis comparing the accuracy of non-radiologist performed ultrasound (NRPUS) for AAA disease to the 'gold standard' of radiologist performed aortic imaging (RPI), intr...
journal_title:International journal of clinical practice
pub_type: 杂志文章,meta分析,评审
doi:10.1111/ijcp.12453
更新日期:2014-09-01 00:00:00
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journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/ijcp.13077
更新日期:2018-05-01 00:00:00
abstract::TT virus (TTV) is a novel DNA virus that has been identified in patients with post-transfusional hepatitis of unknown aetiology. However, its pathogenic role in liver injury remains unclear. To determine its frequency and clinical impact in cryptogenic liver diseases, we investigated the TTV prevalence in patients wit...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:
更新日期:2001-09-01 00:00:00
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journal_title:International journal of clinical practice
pub_type: 杂志文章
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更新日期:2020-10-01 00:00:00
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journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1742-1241.2006.01249.x
更新日期:2007-02-01 00:00:00
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journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/j.1742-1241.2012.02942.x
更新日期:2012-08-01 00:00:00
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journal_title:International journal of clinical practice
pub_type: 杂志文章
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更新日期:2019-10-01 00:00:00
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journal_title:International journal of clinical practice
pub_type: 杂志文章,随机对照试验
doi:10.1111/ijcp.12857
更新日期:2016-09-01 00:00:00
abstract:OBJECTIVE:The ENDURANCE study evaluated the efficacy of vardenafil, a phosphodiesterase type 5 (PDE5) inhibitor, in men with erectile dysfunction (ED), by measuring the duration of erection leading to successful intercourse using a stopwatch as the assessment instrument. METHODS:This was a randomised, multicentre, dou...
journal_title:International journal of clinical practice
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1111/j.1742-1241.2008.01947.x
更新日期:2009-01-01 00:00:00
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journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
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更新日期:2012-06-01 00:00:00
abstract:BACKGROUND:Incretin-based therapies offer another treatment option for patients with type 2 diabetes. Agents that provide glycaemic control in addition to attenuating cardiovascular disease (CVD) risk factors are important for diabetes management. This review will focus on the off-target effects of incretin-based thera...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:10.1111/ijcp.12572
更新日期:2015-05-01 00:00:00
abstract::Snoring is a very common source of complaints from partners and neighbours. Snorers themselves are less likely to be affected, unless they have associated daytime sleepiness caused by the sleep disruption from obstructive sleep apnoea. There is increasingly firm evidence that obstructive sleep apnoea is associated wit...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:
更新日期:2003-11-01 00:00:00
abstract::Exaggerated reactions to insect bites are characteristic of patients with haemoproliferative disorders, particularly chronic lymphocytic leukaemia (CLL). Skin lesions usually appear after the diagnosis of leukaemia and seem unrelated to laboratory findings, disease course or therapy. Rarely, the eruption may precede t...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/j.1742-1241.2004.00116.x
更新日期:2004-12-01 00:00:00
abstract::Age-related macular degeneration (AMD) is the leading cause of adult blindness among individuals aged 50 and older in the Western world, with the neovascular form of AMD responsible for the most severe and rapid visual loss. Although monotherapy with currently available treatments can slow the rate of loss of vision i...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1742-1241.2007.01299.x
更新日期:2007-03-01 00:00:00