. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Focus on blood pressure and risk factor intervention Stefan Agewall Editor-in-Chief, Oslo University Hospital Ulleva˚l and Institute of Clinical Sciences, University of Oslo, Oslo, Norway Various drugs increase the risk of out-of-hospital cardiac arrest (OHCA) in the general population by impacting cardiac ion chan- nels, thereby causing ventricular tachycardia/fibrillation (VT/VF). 1,2 Dihydropyridines block L-type calcium channels, but their association with OHCA risk is less well known. In this issue of the journal, Tan and co-workers aimed to study whether nifedipine and/or amlodi- pine, commonly used dihydropyridines, were associated with increased OHCA risk, and how these drugs impact on cardiac elec- trophysiology. The authors conducted a case–control study with VT/ VF-documented OHCA cases with a presumed cardiac cause from ongoing population-based OHCA registries in the Netherlands and Denmark. They concluded that high-dose nifedipine, but not low- dose nifedipine or any dose of amlodipine, was associated with increased OHCA risk in the general population. It is unclear whether intensive blood pressure lowering is well tol- erated and modifies risk uniformly across the age spectrum. Dr Pareek and co-workers analysed the SPRINT study. 3 SPRINT randomized 9361 high-risk adults without diabetes and aged >_50 years with systolic blood pressure 130–180 mmHg to either intensive or standard antihypertensive treatment. The primary efficacy end- point was the composite of acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. The primary safety end- point was composite serious adverse events. The authors report that in the SPRINT study, the benefits and risks of intensive blood pres- sure lowering did not differ according to the age categories proposed by the ESC/ESH guidelines for hypertension. 4 In a study by Schmieder et al. from Germany, the aim was to ana- lyse the efficacy of two combination therapies on vascular function in subjects with type 2 diabetes mellitus (T2DM). Subjects were randomized to either the combination therapy empagliflozin 10 mg with linagliptin 5 mg once daily or metformin 850 or 1000 mg twice daily with insulin once daily. The authors concluded that beyond the effects on glycaemic control, the combination therapy of empagliflo- zin þ linagliptin significantly improved central blood pressure and vas- cular function compared with the classic combination of metformin þ insulin. In another study from Germany, Dr Orban and co-workers ana- lyse variations in antiplatelet drug response and clinical outcomes 5–7 between smokers and non-smokers. The multicentre TROPICAL- ACS trial 8 randomized 2610 acute coronary syndrome patients 1:1 to standard treatment with prasugrel for 12 months (control group) or a platelet function testing-guided de-escalation of dual antiplatelet therapy (DAPT). Current smokers (n = 1182) showed comparable event rates between study groups. In non-smokers (n = 1428), a guided DAPT de-escalation was associated with a lower 1-year inci- dence of the primary endpoint compared with control group patients. This paper is accompanied by an Editorial by Dr Flather. Furthermore, it is a pleasure to publish a position paper from the ESC Council on Hypertension entitled ‘Peripartum management of hypertension. A position paper of the ESC Council on Hypertension and the European Society of Hypertension’. 9,10 In a review paper, Dr Galati and co-workers discuss new advances in pharmacological treatment both in cardiovascular prevention and in heart failure management with a special focus on T2DM patients. A large number of randomized clinical trials and meta-analyses have provided strong evidence about therapeutic strategies acting on glu- cose metabolism such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium–glucose co-transporter-2 (SGLT2) inhibi- tors and about lipid-lowering treatment such as proprotein conver- tase subtilisin/kexin type 9 (PCSK9) inhibitors and icosapent ethyl. Moreover, SGLT2 inhibitors demonstrated strong evidence of bene- fit particularly in heart failure management in both diabetic and non- diabetic patients. These new drugs in the cardiovascular therapeutic armamentarium are establishing a new comprehensive approach from prevention to therapy of heart failure. References 1. Fukuda T, Kondo Y, Hayashida K, Sekiguchi H, Kukita I. Time to epinephrine and survival after paediatric out-of-hospital cardiac arrest. Eur Heart J Cardiovasc Pharmacother 2018;4:144–151. 2. Grimfja¨rd P, Lagerqvist B, Erlinge D, Varenhorst C, James S. Clinical use of cangre- lor: nationwide experience from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Eur Heart J Cardiovasc Pharmacother 2019;5:151–157. Published on behalf of the European Society of Cardiology. All rights reserved. VC The Author(s) 2020. For permissions, please email: journals.permissions@oup.com. European Heart Journal - Cardiovascular Pharmacotherapy (2020) 6, 339–340 EDITORIAL doi:10.1093/ehjcvp/pvaa130 Downloaded from https://academic.oup.com/ehjcvp/article/6/6/339/5983762 by guest on 06 June 2024