Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Cardiology and Therapy
Published in: Cardiology and Therapy 1/2021

Open Access 01-06-2021 | Heart Failure | Review

Contemporary Strategies to Manage High Blood Pressure in Patients with Coexistent Resistant Hypertension and Heart Failure With Reduced Ejection Fraction

Authors: Katherine Lang, Erik H. Van Iterson, Luke J. Laffin

Published in: Cardiology and Therapy | Issue 1/2021

Login to get access

Abstract

Resistant hypertension (RH) represents an advanced subtype of hypertension that is complex to diagnose and treat. Compared with general hypertension, RH increases the risk patients will develop more advanced cardiovascular complications, including heart failure with reduced ejection fraction (HFrEF). As expected, the prevalence of RH has increased since the introduction of lower blood pressure targets included in the recent 2017 American blood pressure guidelines. The array of pharmacotherapies available to treat both hypertension and HFrEF has also expanded within the past decade. However, the efficacy of these cutting-edge pharmacotherapies has not come without a more advanced understanding of the important adjunct role non-pharmacological therapies play in helping with the management of both hypertension and HFrEF. In this review, we provide a summary of the latest pharmacological and non-pharmacological strategies that can be used to initiate treatment and optimize long-term blood pressure control in patients with coexistent RH and HFrEF.
Literature
1.
Lawes CM, Vander Hoorn S, Rodgers A, International Society of H. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371:1513–8.PubMed
2.
Collaboration NCDRF. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 191 million participants. Lancet. 2017;389:37–55.
3.
Sprint Research Group, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103–16.
4.
Whelton PK, Carey RM, Aronow WS, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;71:e127-248.PubMed
5.
Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020;141:e139–596.PubMed
6.
Carey RM, Calhoun DA, Bakris GL, et al. Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association. Hypertension. 2018;72:e53–90.PubMedPubMedCentral
7.
Dudenbostel T, Siddiqui M, Gharpure N, Calhoun DA. Refractory versus resistant hypertension: novel distinctive phenotypes. J Nat Sci 2017;3(9).
8.
Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136:e137–61.PubMed
9.
Breslow NE, Day NE (1987) Effects of treatment on morbidity in hypertension II: results in patients with diastolic blood pressure averaging 90 through 114 mmHg. JAMA 131–5.
10.
Kostis JB, Davis BR, Cutler J, et al. Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. SHEP Cooperative Research Group. JAMA. 1997;278:212–6.PubMed
11.
Egan BM, Zhao Y, Axon RN, Brzezinski WA, Ferdinand KC. Uncontrolled and apparent treatment resistant hypertension in the United States, 1988 to 2008. Circulation. 2011;124:1046–58.PubMedPubMedCentral
12.
13.
Patel KV, Li X, Kondamudi N, et al. Prevalence of apparent treatment-resistant hypertension in the United States according to the 2017 high blood pressure guideline. Mayo Clin Proc. 2019;94:776–82.PubMed
14.
United States Census Bureau. Table 2 Projected age and sex composition of the population. Projections for the United States. Suitland: United States Census Bureau; 2017. p. 2017–60.
15.
Levy D, Kenchaiah S, Larson MG, et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med. 2002;347:1397–402.PubMed
16.
Jackson SL, Tong X, King RJ, Loustalot F, Hong Y, Ritchey MD. National burden of heart failure events in the United States, 2006 to 2014. Circ Heart Fail. 2018;11:e004873.PubMedPubMedCentral
17.
Jin CN, Liu M, Sun JP, et al. The prevalence and prognosis of resistant hypertension in patients with heart failure. PLoS ONE. 2014;9:e114958.PubMedPubMedCentral
18.
Daugherty SL, Powers JD, Magid DJ, et al. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation. 2012;125:1635–42.PubMedPubMedCentral
19.
Sim JJ, Bhandari SK, Shi J, et al. Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension. Kidney Int. 2015;88:622–32.PubMedPubMedCentral
20.
Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997;336:1117–24.PubMed
21.
Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344:3–10.PubMed
22.
Pimenta E, Gaddam KK, Oparil S, et al. Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension: results from a randomized trial. Hypertension. 2009;54:475–81.PubMedPubMedCentral
23.
Writing Committee M, Yancy CW, Jessup M, et al. 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. Circulation. 2013;128:e240-327.
24.
Doukky R, Avery E, Mangla A, et al. Impact of dietary sodium restriction on heart failure outcomes. JACC Heart Fail. 2016;4:24–35.PubMedPubMedCentral
25.
Cornelissen VA, Buys R, Smart NA. Endurance exercise beneficially affects ambulatory blood pressure: a systematic review and meta-analysis. J Hypertens. 2013;31:639–48.PubMed
26.
Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2:e004473.PubMedPubMedCentral
27.
Dimeo F, Pagonas N, Seibert F, Arndt R, Zidek W, Westhoff TH. Aerobic exercise reduces blood pressure in resistant hypertension. Hypertension. 2012;60:653–8.PubMed
28.
Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. JAMA. 2018;320:2020–8.PubMed
29.
O’Connor CM, Whellan DJ, Lee KL, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009;301:1439–50.PubMedPubMedCentral
30.
Taylor RS, Sagar VA, Davies EJ, et al. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev. 2014;2014:CD003331.PubMedCentral
31.
Taylor RS, Walker S, Smart NA, et al. Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation: an individual patient data meta-analysis of randomised trials. Eur J Heart Fail. 2018;20:1735–43.PubMedPubMedCentral
32.
Piepoli MF, Corra U, Benzer W, et al. Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2010;17:1–17.PubMed
33.
Fletcher GF, Ades PA, Kligfield P, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013;128:873–934.PubMed
34.
Decision Memorandum for Coverage of Cardiac Rehabilitation (CR) Programs for Chronic Heart Failure (HF). The Centers for Medicare & Medicaid Services (CMS). § 41049(b)(1)(vii). United States of America, 2014:24.
35.
Yancy C, Jessup M, Bozkurt B, et al. 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. Circulation. 2013;128:1810–52.PubMed
36.
Austin J, Williams WR, Ross L, Hutchison S. Five-year follow-up findings from a randomized controlled trial of cardiac rehabilitation for heart failure. Eur J Cardiovasc Prev Rehabil. 2008;15:162–7.PubMed
37.
Van Iterson EH, Johnson BD, Joyner MJ, Curry TB, Olson TP. Vo2 kinetics associated with moderate-intensity exercise in heart failure: impact of intrathecal fentanyl inhibition of group III/IV locomotor muscle afferents. Am J Physiol Heart Circ Physiol. 2017;313:H114–24.PubMedPubMedCentral
38.
Van Iterson EH, Snyder EM, Joyner MJ, Johnson BD, Olson TP. Intrathecal fentanyl blockade of afferent neural feedback from skeletal muscle during exercise in heart failure patients: Influence on circulatory power and pulmonary vascular capacitance. Int J Cardiol. 2015;201:384–93.PubMedPubMedCentral
39.
Van Iterson EH, Snyder EM, Johnson BD, Olson TP. Influence of the metaboreflex on pulmonary vascular capacitance in heart failure. Med Sci Sports Exerc. 2016;48:353–62.PubMedPubMedCentral
40.
41.
Coats AJS, Forman DE, Haykowsky M, et al. Physical function and exercise training in older patients with heart failure. Nat Rev Cardiol. 2017;14:550–9.PubMed
42.
Piepoli M, Ponikowski P, Clark AL, Banasiak W, Capucci A, Coats AJS. A neural link to explain the “muscle hypothesis” of exercise intolerance in chronic heart failure. Am Heart J. 1999;137:1050–6.PubMed
43.
Piepoli M, Clark AL, Volterrani M, Adamopoulos S, Sleight P, Coats AJ. Contribution of muscle afferents to the hemodynamic, autonomic, and ventilatory responses to exercise in patients with chronic heart failure: effects of physical training. Circulation. 1996;93:940–52.PubMed
44.
Blomqvist CG, Saltin B. Cardiovascular adaptations to physical training. Annu Rev Physiol. 1983;45:169–89.PubMed
45.
Goldsmith RL, Bigger JT Jr, Steinman RC, Fleiss JL. Comparison of 24-hour parasympathetic activity in endurance-trained and untrained young men. J Am Coll Cardiol. 1992;20:552–8.PubMed
46.
Hartley LH, Mason JW, Hogan RP, et al. Multiple hormonal responses to prolonged exercise in relation to physical training. J Appl Physiol. 1972;33:607–10.PubMed
47.
La Rovere MT, Bersano C, Gnemmi M, Specchia G, Schwartz PJ. Exercise-induced increase in baroreflex sensitivity predicts improved prognosis after myocardial infarction. Circulation. 2002;106:945–9.PubMed
48.
Joyner MJ. Baroreceptor function during exercise: resetting the record. Exp Physiol. 2006;91:27–36.PubMed
49.
Unger T, Borghi C, Charchar F, et al. 2020 international society of hypertension global hypertension practice guidelines. Hypertension. 2020;75:1334–57.PubMed
50.
McMurray JJ, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993–1004.PubMed
51.
Seferovic PM, Ponikowski P, Anker SD, et al. Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019;21:1169–86.PubMed
52.
Jhund PS, Fu M, Bayram E, et al. Efficacy and safety of LCZ696 (sacubitril-valsartan) according to age: insights from PARADIGM-HF. Eur Heart J. 2015;36:2576–84.PubMedPubMedCentral
53.
Simpson J, Jhund PS, Cardoso JS, et al. Comparing LCZ696 with enalapril according to baseline risk using the MAGGIC and EMPHASIS-HF risk scores: an analysis of mortality and morbidity in PARADIGM-HF. J Am Coll Cardiol. 2015;66:2059–71.PubMed
54.
Okumura N, Jhund PS, Gong J, et al. Effects of Sacubitril/Valsartan in the PARADIGM-HF trial (prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in heart failure) according to background therapy. Circ Heart Fail. 2016;9:e003212.PubMed
55.
Velazquez EJ, Morrow DA, DeVore AD, et al. Angiotensin–neprilysin inhibition in acute decompensated heart failure. N Engl J Med. 2019;380:539–48.PubMed
56.
Kjeldsen SE, Narkiewicz K, Burnier M, Oparil S. Will we ever use angiotensin receptor neprilysin inhibition (ARNi) for the treatment of hypertension? Blood Press. 2019;28:75–6.PubMed
57.
Anderson SL, Marrs JC. Sacubitril/valsartan: evaluation of safety and efficacy as an antihypertensive treatment. Drugs Context. 2018;7:212542.PubMedPubMedCentral
58.
Ruilope LM, Dukat A, Bohm M, Lacourciere Y, Gong J, Lefkowitz MP. Blood-pressure reduction with LCZ696, a novel dual-acting inhibitor of the angiotensin II receptor and neprilysin: a randomised, double-blind, placebo-controlled, active comparator study. Lancet. 2010;375:1255–66.PubMed
59.
Bakris GL, Fonseca V, Katholi RE, et al. Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. JAMA. 2004;292:2227–36.PubMed
60.
Reubi FC, Cottier PT. Effects of reduced glomerular filtration rate on responsiveness to chlorothiazide and mercurial diuretics. Circulation. 1961;23:200–10.PubMed
61.
DiNicolantonio JJ, Bhutani J, Lavie CJ, O’Keefe JH. Evidence-based diuretics: focus on chlorthalidone and indapamide. Future Cardiol. 2015;11:203–17.PubMed
62.
Kaplan NM. The choice of thiazide diuretics: why chlorthalidone may replace hydrochlorothiazide. Hypertension. 2009;54:951–3.PubMed
63.
Roush GC, Sica DA. Diuretics for hypertension: a review and update. Am J Hypertens. 2016;29:1130–7.PubMed
64.
Bobrie G, Frank M, Azizi M, et al. Sequential nephron blockade versus sequential renin–angiotensin system blockade in resistant hypertension: a prospective, randomized, open blinded endpoint study. J Hypertens. 2012;30:1656–64.PubMed
65.
66.
Brown JM, Siddiqui M, Calhoun DA, et al. The unrecognized prevalence of primary aldosteronism: a cross-sectional study. Ann Intern Med. 2020;173:10–20.PubMedPubMedCentral
67.
Williams B, MacDonald TM, Morant S, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet. 2015;386:2059–68.PubMedPubMedCentral
68.
Williams B, MacDonald TM, Morant SV, et al. Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY-2 mechanisms substudies. Lancet Diabetes Endocrinol. 2018;6:464–75.PubMedPubMedCentral
69.
Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341:709–17.PubMed
70.
Zannad F, McMurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364:11–21.PubMed
71.
Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348:1309–21.PubMed
72.
McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381:1995–2008.PubMed
73.
Packer M, Anker SD, Butler J, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med. 2020;383:1413–24.PubMed
74.
Briasoulis A, Al Dhaybi O, Bakris GL. SGLT2 inhibitors and mechanisms of hypertension. Curr Cardiol Rep. 2018;20:1.PubMed
75.
Georgianos PI, Agarwal R. Ambulatory blood pressure reduction with SGLT-2 inhibitors: dose-response meta-analysis and comparative evaluation with low-dose hydrochlorothiazide. Diabetes Care. 2019;42:693–700.PubMedPubMedCentral
76.
Kario K, Okada K, Kato M, et al. 24-hour blood pressure-lowering effect of an SGLT-2 inhibitor in patients with diabetes and uncontrolled nocturnal hypertension: results from the randomized, placebo-controlled SACRA study. Circulation. 2018;139(18):2089.PubMedCentral
77.
Kandler MR, Mah GT, Tejani AM, Stabler SN, Salzwedel DM. Hydralazine for essential hypertension. Cochrane Database Syst Rev. 2011;2011:CD004934.
78.
Cohn JN, Archibald DG, Ziesche S, et al. Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study. N Engl J Med. 1986;314:1547–52.PubMed
79.
Carson P, Ziesche S, Johnson G, Cohn JN. Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group. J Card Fail. 1999;5:178–87.PubMed
80.
Cohn JN, Ziesche S, Smith R, et al. Effect of the calcium antagonist felodipine as supplementary vasodilator therapy in patients with chronic heart failure treated with enalapril: V-HeFT III. Vasodilator-heart failure trial (V-HeFT) study group. Circulation. 1997;96:856–63.PubMed
81.
Udelson JE, DeAbate CA, Berk M, et al. Effects of amlodipine on exercise tolerance, quality of life, and left ventricular function in patients with heart failure from left ventricular systolic dysfunction. Am Heart J. 2000;139:503–10.PubMed
82.
Multicenter Diltiazem Postinfarction Trial Research G. The effect of diltiazem on mortality and reinfarction after myocardial infarction. N Engl J Med. 1988;319:385–92.
83.
Ferreira JP, Butler J, Rossignol P, et al. Abnormalities of potassium in heart failure: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;75:2836–50.PubMed
84.
Packham DK, Rasmussen HS, Lavin PT, et al. Sodium zirconium cyclosilicate in hyperkalemia. N Engl J Med. 2015;372:222–31.PubMed
85.
Anker SD, Kosiborod M, Zannad F, et al. Maintenance of serum potassium with sodium zirconium cyclosilicate (ZS-9) in heart failure patients: results from a phase 3 randomized, double-blind, placebo-controlled trial. Eur J Heart Fail. 2015;17:1050–6.PubMedPubMedCentral
86.
Weir MR, Bakris GL, Bushinsky DA, et al. Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. N Engl J Med. 2015;372:211–21.PubMed
87.
Uijl E, Mirabito Colafella KM, Sun Y, et al. Strong and sustained antihypertensive effect of small interfering RNA targeting liver angiotensinogen. Hypertension. 2019;73:1249–57.PubMed
88.
Ren L, Colafella KMM, Bovee DM, Uijl E, Danser AHJ. Targeting angiotensinogen with RNA-based therapeutics. Curr Opin Nephrol Hypertens. 2020;29:180–9.PubMed
89.
Raal FJ, Kallend D, Ray KK, et al. Inclisiran for the treatment of heterozygous familial hypercholesterolemia. N Engl J Med. 2020;382:1520–30.PubMed
90.
Laffin LJ, Bakris GL. Catheter-based renal denervation for resistant hypertension: will it ever be ready for “prime time”? Am J Hypertens. 2017;30:841–6.PubMed
91.
Bhatt DL, Kandzari DE, O’Neill WW, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med. 2014;370:1393–401.PubMed
92.
Desch S, Okon T, Heinemann D, et al. Randomized sham-controlled trial of renal sympathetic denervation in mild resistant hypertension. Hypertension. 2015;65:1202–8.PubMed
93.
Mathiassen ON, Vase H, Bech JN, et al. Renal denervation in treatment-resistant essential hypertension. A randomized, SHAM-controlled, double-blinded 24-h blood pressure-based trial. J Hypertens. 2016;34:1639–47.PubMedPubMedCentral
94.
Bohm M, Kario K, Kandzari DE, et al. Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial. Lancet. 2020;395:1444–51.PubMed
95.
Fukuta H, Goto T, Wakami K, Ohte N. Effects of catheter-based renal denervation on heart failure with reduced ejection fraction: a systematic review and meta-analysis. Heart Fail Rev. 2017;22:657–64.PubMed
96.
Laffin LJ, Bakris GL. Hypertension and new treatment approaches targeting the sympathetic nervous system. Curr Opin Pharmacol. 2015;21:20–4.PubMed
97.
Zile MR, Lindenfeld J, Weaver FA, et al. Baroreflex activation therapy in patients with heart failure with reduced ejection fraction. J Am Coll Cardiol. 2020;76:1–13.PubMed
98.
Spiering W, Williams B, Van der Heyden J, et al. Endovascular baroreflex amplification for resistant hypertension: a safety and proof-of-principle clinical study. Lancet. 2017;390:2655–61.PubMed
Metadata
Title
Contemporary Strategies to Manage High Blood Pressure in Patients with Coexistent Resistant Hypertension and Heart Failure With Reduced Ejection Fraction
Authors
Katherine Lang
Erik H. Van Iterson
Luke J. Laffin
Publication date
01-06-2021
Publisher
Springer Healthcare
Published in
Cardiology and Therapy / Issue 1/2021
Print ISSN: 2193-8261
Electronic ISSN: 2193-6544
DOI
https://doi.org/10.1007/s40119-020-00203-5

Other articles of this Issue 1/2021

Cardiology and Therapy 1/2021 Go to the issue

Original Research

Distal Transradial Access for Coronary Angiography and Interventions in Everyday Practice: Data From the TRIANGLE Registry (TwitteR Initiated registry for coronary ANgiography in Germany via distaL radial accEss)

Original Research

Disease Management and Outcomes in Patients Hospitalized for Acute Heart Failure in Japan

Original Research

Correlation Between the 6-Min Walk Test and Exercise Tolerance Test in Cardiac Rehabilitation After Coronary Artery Bypass Grafting: A Cross-sectional Study

Original Research

Effectiveness of Telmisartan on Blood Pressure Control in Hypertensive Patients in India: A Real-World Retrospective Study from Electronic Medical Records

Commentary

Supplementary Therapeutic Possibilities to Alleviate Myocardial Damage Due to Microvascular Dysfunction in Coronavirus Disease 2019 (COVID-19)

Review

Management of Lower Extremity Pain from Chronic Venous Insufficiency: A Comprehensive Review
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits