CLINICAL
NEWS JOURNAL WRAP
tide level from baseline to 180 days.
Results showed that of the 271
patients who completed the study,
liraglutide had no substantial effect
on clinical stability following hospitalization. There also was no significant
effect on any of the study’s secondary end points, including changes in
cardiac structure and function from
baseline to 180 days, 6-minute walk
test distances, the KCCQ clinical sum-
The authors
concluded that
their findings “do
not support the
use of liraglutide
in this clinical
situation.”
mary score, emergency department
visits, and the composites of death
and rehospitalization for HF.
Further, compared to placebo,
liraglutide resulted in reduction in
Hemoglobin A1c and weight loss in
patients with advanced HF and type
2 diabetes mellitus. However, several
safety concerns for these patients
were noted, which “suggest the need
for caution and close monitoring
among clinicians considering initiation of liraglutide and other GLP-1
agonists for weight loss or diabetes
management in patients with HF and
reduced LVEF.”
The authors concluded that their
findings “do not support the use of
liraglutide in this clinical situation.” ■
Margulies KB, Hernandez AF, Redfield MM,
et al. JAMA. 2016;316(5):500-8.
18
CardioSource WorldNews
CLARIFY Findings Suggest Caution in
Using BP-Lowering Treatments for CAD
Patients
Findings from the CLARIFY Trial
presented Aug. 30 during ESC Congress 2016 in Rome and simultaneously published in The Lancet suggest
caution in the use of blood pressure
(BP)-lowering treatment in patients
with coronary artery disease.
Researchers analyzed data from
22,672 patients from 45 countries
(excluding the U.S.) with stable
coronary artery disease who were
enrolled in the CLARIFY registry and
treated for hypertension from November 2009 to June 2010. Systolic and
diastolic BP before each event were
averaged and categorized into 10 mm
Hg increments. The primary outcome
was the composite of cardiovascular
death, myocardial infarction or stroke.
Secondary outcomes were each
component of the primary endpoint,
all-cause death, and hospital admission for heart failure.
After a median follow-up of five
years, increased systolic BP (SBP) of
140 mm Hg or more and diastolic BP
(DBP) of 80 mm Hg or more were
each associated with increased risk
of cardiovascular events. SBP of less
than 120 mm Hg was also associated
with increased risk for the primary
outcome, as well as increased risk for
all secondary outcomes except stroke.
Similarly, DBP of less than 70 mm
Hg was associated with an increase
in the primary outcome and in all
secondary outcomes except stroke.
Study authors said their findings
support the existence of a J-curve
phenomenon. They also point out
that the broad international cohort of
patients who were treated in real-life
conditions is a “particular strength”
of the study and might have greater
external validity than randomized
trials. “There is a concern that low BP
goals from randomized trials, when
translated into routine practice, might
be associated with higher adverse effects or worse outcomes, especially in
older patients,” they said.
Meanwhile, the authors caution
that results from the study “should
not slow down the constant effort
that is still needed to improve patient
care, because even with the conventional pressure goal of less than
140/90 mm Hg, only about half of
the population with hypertension is
controlled.”
Deepak L. Bhatt, MD, MPH,
echoes this sentiment in a commentary published Aug. 30 in JACC. “A
key cautionary note about appropriate BP targets is that the majority of
patients with hypertension are not optimally treated, even using thresholds
higher than those that are currently
being debated,” he writes. “From a
population health perspective, more
would be gained from maintaining
traditional BP targets for the entire
population (perhaps adjusted for
age) while sorting out the nuances of
“From a
populationheatlh
perspective,
more would
be gained by
maintaining
traditional
BP targets
for the entire
population
[...].”
—Deepak Bhatt, MD
who might benefit from tighter BP
control.”
He points out that another study
by McEvoy et al., also published Aug.
30 in JACC, “shows that lower may
not always be better with respect to
BP control and, along with other accumulating evidence, strongly suggests
careful thought before pushing BP
control below current guideline targets, especially if the DBP falls below
60 mm Hg while the pulse pressure is
>60 mm Hg.” ■
Vidal-Petoit E, Ford I, Greenlaw N, et
al. Lancet. 2016;doi:10.1016/S01406736(16)313216-5
Bhatt D. J Am Coll Cardiol.
2016;doi:10.1016/j.jacc.2016.08.007
McEvoy J, Chen Y, Rawlings A, et al. J
Am Coll Cardiol. 2016;doi:10.1016/j.
jacc.2016.07.754
September 2016