Amy M. Franks

Comparison of the Effects of Energy Drink Versus Caffeine Supplementation on Indices of 24-Hour Ambulatory Blood Pressure

Background: Cardiovascular events associated with energy drink consumption have been reported, but few data exist to delineate the hemodynamic effects of energy drinks. Objective: To compare the effects of an energy drink versus caffeine supplementation on blood pressure (BP) Indices as measured by 24-hour ambulatory BP monitoring (ABPM). Methods: Healthy, nonsmoking, normotensive volunteers (aged 18-45 years) taking no medications were enrolled in a single-center, open-label, 2-period crossover pilot study. During each study period, subjects received either an energy drink (Red Bull Energy Drink, each dose containing 80 mg of caffeine and 1000 mg of taurine in an 8.3-oz serving) or a control (compounded caffeine solution, each dose containing 80 mg of caffeine solution in 8 oz of bottled water) at 0800,1100, 1500, and 1900 hours and underwent 24-hour ABPM. The study periods were separated by a washout period (4-30 days). Mean 24-hour, daytime, and nighttime systolic (SBP), diastolic (DBP), and mean arterial (MAP) BP; BP load; and percent nocturnal dipping were compared between study periods. Results: Mine subjects (5 females, mean [SD] age 27.7 [5.0] years) completed the study. Mean 24-hour SBP (123.2 vs 117.4 mm Hg, p = 0.04), DBP (73.6 vs 68.2 mm Hg, p = 0.02), and MAP (90.1 vs 84.8 mm Hg, p = 0.03) were significantly higher during energy drink supplementation versus caffeine supplementation. Daytime DBP (77.0 vs 72.0 mm Hg, p = 0.04) also was significantly higher with the energy drink versus caffeine supplementation. Trends in higher daytime SBP (127.0 vs 121.9 mm Hg, p = 0.05) and MAP (93.6 vs 88.6 mm Hg, p = 0.05) were recorded with energy drink supplementation versus caffeine supplementation. Nighttime SBP and DBP toads were significantly higher with the energy drink, but nocturnal dipping did not differ significantly between study periods. Conclusions: Single-day energy drink supplementation increased mean 24-hour and daytime BP compared to caffeine control in this pilot study. Additional research Is warranted to better understand the hemodynamic effects of energy drink consumption.

Olmesartan Medoxomil: The Seventh Angiotensin Receptor Antagonist

OBJECTIVE To review the pharmacology, pharmacokinetics, efficacy, and adverse effects of olmesartan medoxomil, an angiotensin II receptor antagonist for the treatment of hypertension. DATA SOURCES Information was obtained from MEDLINE searches (1996–April 2002) of English-language medical literature. Search terms included CS-866, olmesartan, olmesartan medoxomil, RNH-6270 (active metabolite of olmesartan), Benicar, angiotensin receptors, and antihypertensive agents. In addition, references from relevant articles were reviewed for additional citations. The authors independently reviewed literature identified in the searches. Studies evaluating olmesartan (i.e., abstracts, clinical trials, data on file with manufacturer) were considered for inclusion. STUDY SELECTION All articles identified from data sources with pertinent information regarding olmesartan medoxomil were evaluated, and all information deemed relevant was included in this review. DATA SYNTHESIS Olmesartan medoxomil is a competitively priced addition to the class of angiotensin II receptor antagonists. Monotherapy with olmesartan medoxomil in once-daily doses of 20–40 mg has produced significant reductions in systolic and diastolic blood pressure in hypertensive patients. Adverse effects have been minimal with olmesartan medoxomil, with dizziness being the only adverse effect occurring more often than with placebo in clinical trials. Additionally, animal studies indicate that olmesartan medoxomil may prove to be useful treatment for diabetic nephropathy, as well as atherosclerosis. CONCLUSIONS Olmesartan medoxomil has a favorable safety and efficacy profile, with blood pressure–lowering effects comparable to those of other angiotensin receptor blockers (i.e., losartan, valsartan, irbesartan). At this time, formulary decisions will be driven primarily by economic issues. Theoretical benefits of olmesartan medoxomil in reducing atherogenesis and lowering angiotensin II concentrations better than the alternative agents will be determined only with more extensive research. THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT ACPE UNIVERSAL PROGRAM NUMBER: 407-000-03-002-H01

Influence of grapefruit juice on the systemic availability of itraconazole oral solution in healthy adult volunteers

Study Objective. To evaluate the effect of repeated ingestion of grapefruit juice on the systemic availability of itraconazole (ITZ) and hydroxy‐itraconazole (OHITZ) serum concentrations in subjects administered hydroxypropyl‐β‐cyclodextrin‐ITZ (HP‐β‐CD ITZ) oral solution.

Effect of the clopidogrel - Proton Pump Inhibitor drug interaction on adverse cardiovascular events in patients with Acute Coronary Syndrome

To examine the effect of the drug interaction between clopidogrel and proton pump inhibitors (PPIs) on the risk of an adverse cardiovascular event.

Evaluation of community health screening participants' knowledge of cardiovascular risk factors

OBJECTIVES To assess knowledge of cardiovascular disease (CVD) risk factors among a group of health screening participants and to compare knowledge between participants with high and low CVD risk. DESIGN Cross-sectional pilot study. SETTING Jonesboro, AR, during June 2007. PATIENTS 121 adult volunteers participating in a community health screening. INTERVENTION 34-item self-administered written questionnaire. MAIN OUTCOME MEASURES Ability to identify CVD risk factors and healthy values for CVD risk factors and the differences in these abilities between participants with high and low CVD risk. RESULTS Participants demonstrated good knowledge of traditional CVD risk factors such as high blood pressure, high cholesterol, lack of exercise, and overweight or obese status. Knowledge of other CVD risk factors and healthy values for major CVD risk factors was limited. Participants with high CVD risk were significantly more likely to correctly identify high triglycerides as a CVD risk factor and to identify healthy values for fasting blood glucose and total cholesterol compared with participants with low CVD risk. CONCLUSION Overall, participants lacked knowledge of the risk factor status and healthy values for many CVD risk factors. Participants with high CVD risk may have better knowledge of some CVD risk factors than participants with low CVD risk. These findings highlight the need for more education to improve knowledge in both risk groups.

Impact of health screening and education on knowledge of coronary heart disease risk factors

OBJECTIVES To evaluate the effects of a community health screening and education intervention on knowledge of coronary heart disease (CHD) risk factors and participation in health-promoting behaviors. DESIGN Descriptive, exploratory, nonexperimental study. SETTING Little Rock, AR, from July 2007 to December 2007. PARTICIPANTS 56 participants recruited from two community health screenings. INTERVENTION Prescreening written questionnaire to determine baseline knowledge of CHD risk factors. Participants underwent risk factor screening (lipid profile, blood glucose, body mass index [BMI], and blood pressure) and received tailored education. A postscreening telephone questionnaire was administered 4 to 8 weeks later. MAIN OUTCOME MEASURES Participant knowledge of CHD risk factors and participation in health-promoting behaviors pre- and postscreening. RESULTS Of the 56 participants enrolled, 45 (80.4%) completed the postscreening telephone survey. Compared with prescreening responses, participants showed significantly greater postscreening knowledge of healthy values for CHD risk factors, including blood pressure (P = 0.02), fasting blood glucose (P = 0.03), fasting total cholesterol (P < 0.01), and BMI (P < 0.01). Following the screening, 20 (44.4%) participants had consulted their primary care provider and 31 (68.8%) made at least one healthy behavior change. Approximately one-half of participants reported changing eating habits, and 5 (11.1%) reported increased exercise. CONCLUSION These results demonstrate that community-based health screening and education interventions can effectively promote public health knowledge and empower participants to engage in health-promoting behaviors.

Candesartan Cilexetil Effectively Reduces Blood Pressure in Hypertensive Children

Background: The angiotensin-receptor blocker candesartan cilexetil is a well-toleraled antihypertensive agent with demonstrated benefits in adults with hypertension. However, there are few data supporting its use in children with hypertension. Objective: To determine the efficacy and tolerability of candesartan cilexetil in the treatment of pediatric hypertension. Methods: In an open-label, uncontrolled pilot study, hypertensive pediatric patients were eligible tor participation if untreated systolic and/or diastolic blood pressure (BP) exceeded the 95th percentile for sex, age, and height. Patients underwent a 7-day washout period prior to initiation of weight-based dosing of candesartan cilexetil (2-8 mg daily). The dose was doubled after 7 days of therapy if inadequate antihypertensive response was determined by clinic-measured casual BP monitoring (CBPM) and home BP monitoring (HBPM). Three methods of BP measurement were compared before and after 2 weeks of treatment with the final dose of candesartan cilexetil: CBPM, HBPM, and 24-hour continuous ambulatory BP monitoring (ABPM). Self-reported adverse effects and clinical laboratory analyses were used to determine tolerability. Results: Eleven patients (mean age 14.2 y) received a final candesartan cilexetil median daily dose of 8 mg (0.13 mg/kg, range 2-16 mg). Study treatment resulted in significant reductions in systolic and diastolic BP as measured by CBPM (-7.4%, p = 0,03 and -5.9%, p = 0.01, respectively) and by ABPM (-6.0%, p = 0.03 and -10.8%, p = 0.006, respectively), but no significant reductions as measured by HBPM. No clinically significant changes in laboratory measures were observed, and patients reported nonspecific mild adverse effects. Conclusions: Candesartan cilexetil effectively reduced BP as demonstrated by CBPM and ABPM measurements and was well tolerated in this group of hypertensive children.

Severe Anaphylactic Reaction After Repeated Intermittent Exposure to Lepirudin

Lepirudin, a recombinant DNA derivative of hirudin, is used to prevent thromboembolic complications caused by heparin‐induced thrombocytopenia type II. Anaphylactic and anaphylactoid reactions have been reported with its use in patients both with and without known previous exposure to lepirudin. We describe the case of a 57‐year‐old woman who received five uneventful courses of lepirudin therapy before having a severe anaphylactic reaction during administration of the intravenous bolus dose that began her sixth course. The patient experienced cardiorespiratory arrest but recovered from the reaction. The decision to administer lepirudin to a patient who has previously received it should be reached with due consideration of the risk:benefit ratio and strategies to manage risk resulting from readministration. Risk factors for an anaphylactic reaction to lepirudin may include use of an initial bolus dose, intravenous rather than subcutaneous administration, length of any single course of therapy beyond 3 days, and repeat administration of lepirudin within 100 days.

β-Adrenergic Antagonists in Hypertension: A Review of the Evidence

Objective: To evaluate the effects of β-adrenergic antagonist therapy on cardiovascular and cerebrovascular outcomes in the treatment of hypertension. Data Sources: Literature searches were conducted using MEDLINE (1966–August 2009), International Pharmaceutical Abstracts (1970–August 2009), and Cochrane Database of Systematic Reviews (until third quarter 2009) to locate clinical trials and meta-analyses comparing β-blocker therapy with placebo or other antihypertensive agents in patients with hypertension. Bibliographies from relevant research and review articles were reviewed for additional references. Study Selection and Data Extraction: All English-language articles identified from the data sources were reviewed. Articles describing original research with cardiovascular or cerebrovascular outcomes and/or death as either primary or secondary endpoints were included. Articles describing the use of β-blocker therapy for conditions other than hypertension were not included, Data Synthesis: Five placebo-controlled studies and 10 active-controlled studies were reviewed. In addition, 11 meta-analyses were evaluated. Placebo-controlled trials of β-blockers in hypertension provide evidence of reduced risk for stroke, cardiovascular events, and heart failure. Only 2 studies comparing β-blockers with other antihypertensives found significant benefit with β-blockers. However, the majority of meta-analyses comparing β-blockers with other antihypertensive agents show increased risk for stroke with β-blockers, and some data suggest increased risk for cardiovascular events and all-cause mortality. The majority of data results from studies of atenolol, and many studies employed combination antihypertensive therapies, which often included thiazide diuretics. Conclusions: Overall, data supporting β-blockers as preferred therapy in hypertension are inadequate. Although most negative cardiovascular and cerebrovascular outcomes of β-blockers were associated with atenolol therapy, data supporting other β-blockers in hypertension are lacking.

Examining Medication Adherence in Older Women with Coronary Heart Disease

The purposes of this study were to examine medication adherence in older women with coronary heart disease and to identify barriers and facilitators of medication adherence. Methods: The study used a semistructured interview guide and established measures to examine medication taking 3 months after hospital discharge. Results: Thirty-two women completed the study: 65.6% were adherent to medications, but others were less adherent and self-modified their therapy. Over half (52.1%) suffered side effects, 71.9% had experienced psychological barriers, and all had economic barriers. Facilitators included a pillbox system (85%) and discharge medication counseling (90%). Conclusion: Tailored interventions to improve adherence in older women are needed.