Therapeutics Initiative Profile picture
Feb 2, 2022 9 tweets 9 min read Read on X
THREAD: Primary #hypertension therapy: after thiazides, an ACEI or an ARB?

1/8 Nearly 650,000 British Columbians took an ACEI or ARB in 2021

Our new TI Therapeutics Letter reiterates evidence for one of the most common primary care tx choices: ti.ubc.ca/letter133

#MedEd
2/8 Lower #BloodPressure not the Main Goal

#Antihypertensives lower various measures of blood pressure (BP) 💊

But... not all BP lowering drugs are proven to reduce both morbidity & mortality

👉🏾ti.ubc.ca/letter133

#MedEd #prescribing #hypertension
3/8 The importance of clinical outcomes

Basing decisions on which drug lowers #BloodPressure the best cannot guarantee the best clinical outcomes

Read our Therapeutics Letter on optimal 1st and 2nd line treatments: ti.ubc.ca/letter133

#MedEd #prescribing #hypertension
4/8 First best choice: Low dose thiazides

Evidence strongly points to thiazide/thiazide-like diuretics as best choice for 1⃣st-line tx, supported by @CochraneLibrary reviews.

This class reduces mortality, morbidity and is inexpensive

👉🏾More here: bit.ly/3HdFCVt
5/8 What about 2⃣nd choice #antihypertensives?

ACEIs vs ARBS:
Both drug classes reduce #BloodPressure to similar extents but only ACEIs have evidence for a reduction in risk of morbidity & mortality. So, they'd be your 2nd choice after low dose thiazides.

#MedEd #prescribing
6/8 Who should take an ARB?💊

Currently available evidence suggests we save ARBs for pts who cannot tolerate an ACEI

Up to 13% of pts experience cough associated with ACEIs, although only about 1-3% stop taking them

👉🏽More here: ti.ubc.ca/letter133

#MedEd #hypertension
7/8 Don’t Max Out: Don’t use more than ½ max dose of ACEI

✅Higher doses do NOT meaningfully reduce #BloodPressure further

✅½ of max dose of ACEI/ARB produces 90% & 80% of BP lowering of max dose, respectively

👉🏽Our Letter on dose titration: bit.ly/3G58QV7

#MedEd
8/8 Thiazides & skin cancer risk

We don't presently know whether thiazides cause skin cancer and are studying this association.

We maintain that at this time low dose thiazides are still 1st choice in reducing outcomes most important to pts

👉🏾More here: bit.ly/3olOu41
@threadreaderapp unroll, por favor?

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Therapeutics Initiative

Therapeutics Initiative Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @Drug_Evidence

Oct 10
🧵Safe diabetes treatment for older adults
👉🏽

1/ Risks of harms from side effects

⚠️For diabetes meds, low blood sugar is one of the most important side effects
⚠️Sulfonylureas & insulins are the drugs most likely to cause low blood sugar

#ptsafety #T2DM ti.ubc.ca/letter151Image
2/ Isn’t low A1c always good?

Trials w/ tens of thousands of pts looked at effects of achieving A1c < 7% for older ppl & found:

❌ No benefit to A1c < 7%, compared w/ more relaxed value of 7.5-8%
⚠️ A1c < 7% raises chance of dangerously low blood sugar

ti.ubc.ca/letter151Image
3/ What glycemic target to choose for older adults?

@ChooseWiselyCA provides the following reasonable glycemic 🎯:

🟢Healthy older ppl w/ long life expectancy: 7-7.5%
🟡Moderate comorbidity, life expectancy <10 yr: 7.5-8%
🔴Multiple morbidities, shorter life expectancy: 8-8.5% Image
Read 8 tweets
Nov 30, 2022
🧵 How well do you know your dopamine antagonists? 💊💊

1/ Using these drugs safely requires that clinicians & patients appreciate their important #AdverseEffects, which are not always well understood

👉🏽ti.ubc.ca/letter139

#MedEd #prescribing #deprescribing #medsafety
2/ #AdverseEffects may include:

⚠️ Drug-induced #Parkinsonism
-↘️ or slowed movements, rigidity/tremor/unsteadiness, facial expression loss

⚠️ #Akathisia
-intense internal restlessness or desire to move (which may be mistaken for anxiety)

👉🏽Pt videos: ti.ubc.ca/letter139
3/ #AdverseEffects may include:

⚠️Acute dystonic reaction
-sudden, involuntary, often painful muscle spasm

⚠️Dyskinesia
-repetitive, involuntary movements...can be associated with cognitive decline

👉🏽Pt experience videos: ti.ubc.ca/letter139

#MedEd #ptsafety #drugsafety
Read 7 tweets
Nov 3, 2022
🧵 Reducing unnecessary use of proton pump inhibitors (PPIs)

1/ Many people take #PPIs but up to 50% don’t have a good reason to take them > 8 wks

Read on for tips on how you as a clinician can work together with pts to decide if/how to 🛑 or reduce PPIs

#MedEd #deprescribing Image
2/ Does this person need #PPIs long-term (> 8 wks)?
 
Find pts who might not need long-term PPI:
1⃣ Flag refill requests
2⃣ Use a poster or video in waiting room
3⃣ Run EMR report
 
This @bmj_latest article has more tips to help with #deprescribing PPIs: bit.ly/3fisHsT
3/ Indications for long-term #PPIs include:

Barrett’s esophagus, previous bleeding ulcer, chronic NSAID use w/ mod/severe bleed risk, severe esophagitis, Zollinger-Ellison syndrome
 
If no indication for long-term PPI + no ongoing upper GI symptoms, discuss poss #deprescribing Image
Read 7 tweets
Sep 15, 2022
🧵 Reducing #PrescribingCascades ⬇️

1/ What are #Prescribing Cascades?

1⃣ A drug is prescribed 💊
2⃣ #AdverseEvent occurs but is misinterpreted as a new medical condition ⚠️
3⃣Another drug is prescribed for the drug-induced adverse event 💊💊

ti.ubc.ca/letter138 #MedEd Image
2/ Anticholinergics ➡️ cognitive dysfunction ➡️ drugs for #dementia

#Anticholinergic 💊 block acetylcholinergic neurotransmission in the brain, impairing cognition & memory

Can lead to new Rx or ↗️ acetylcholinesterase inhibitor doses

ti.ubc.ca/letter138 #MedEd #FOAMed Image
3/ Drugs for #dementia ➡️ incontinence ➡️ anticholinergics

Conversely, AChE-I can cause urinary or fecal incontinence, that may "cascade" to prescription of an #anticholinergic

👉🏽 full Letter here: ti.ubc.ca/letter138

#MedEd #PrescribingCascades #MedTwitter Image
Read 10 tweets
May 26, 2022
THREAD: #Prescribers, how do YOU respond to Conflicts of Interest (COI)? 👀

1/8 This thread looks at the issues highlighted in our TI Therapeutics Letter on COI

👉🏼Full Letter: ti.ubc.ca/letter136

#ConflictofInterest #MedEd #MedicalEthics
2/8 Kirsten is a clinical pharmacist attending a primary care conference👩🏽‍⚕️

When a keynote speaker reports financial relationships💰with several drug companies, Kirsten takes note🤨

Find out why she prefers #MedEd free of commercial sponsorship: ti.ubc.ca/letter136
3/8 Key Opinion Leaders (KOLs)

It's common practice to cultivate “expert” KOLs who are crucial to market success💵of a new drug

Payments to KOLs are reported in USA but similar disclosure does NOT exist in Canada
go.nature.com/39XdVVq

#FinancialInterests #ConflictofInterest
Read 9 tweets
May 16, 2022
THREAD: Online Portraits for BC family physicians

1/7 UBC’s Therapeutics Initiative now has Online #PrescribingPortraits: ti.ubc.ca/portrait

✅ Timely evidence
✅ Personalized, confidential prescribing data
✅ Recommendations to support

#BetterPrescribing & #BetterHealth Image
2/7 Why have a #PrescribingPortrait?

"How do I prescribe compared to others or to evidence standards?"

✅Portrait does NOT tell individual doctors how to practice
✅Portrait DOES promote optimal prescribing based on best available evidence

More here: ti.ubc.ca/portrait Image
3/7 BC family physicians: How do you prescribe ACEIs and ARBs for #hypertension?

✅Register for your Online #PrescribingPortrait: ti.ubc.ca/portrait

✅View a sample portrait on prescribing of antihypertensives: ti.ubc.ca/2022/01/28/ace…

#BetterPrescribing #MedEd Image
Read 8 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

:(