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
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More from @Drug_Evidence

Jan 21
THREAD: #ExercisePrescriptions

1/5 The TI’s Dr. Josh Levin asks:

Clinicians, can you help your patients be more active? 🏃🏾‍♀️🏊🏾‍♂️ 🚶🏾‍♂️

👉🏾Watch Dr. Levin’s recent presentation: bit.ly/3nLCEje 👨🏾‍💻

#Exercise #prescribing #twitterRx
2/5 #ExercisePrescriptions: How much activity should people get? It depends on their age.

👉🏾See the Canadian Society for Exercise Physiology activity guidelines for different age groups: csepguidelines.ca 🏊🏾‍♂️🏃🏾‍♀️🚶🏾

#Exercise #prescribing #twitterRx #BetterHealth
3/5 Below is an example of an #ExercisePrescription 🏊🏾‍♂️🏃🏾‍♀️🚶🏾‍♂️

#Exercise #prescribing #twitterRx #BetterPrescribing
Read 6 tweets
Nov 27, 2021
THREAD: SGLT2 inhibitors for #diabetes

1/5 Dr. Jamie Falk @jamisonfalk presented "A Deep Dive into #SGLT2i: What Comes to the Surface for Individuals with Diabetes"

👉🏽Watch the presentation here: bit.ly/3FRCEoM 🧑🏾‍💻

#T2DM #medsafety #FOAMed #MedEd
2/5 #AdverseEffects for #SGLT2i to be aware of: genital infections, hypovolemia, DKA, amputations

✅Check out the image ⬇️ for the risk estimates
✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾‍💻

#T2DM #medsafety #FOAMed #MedEd #diabetes #ptsafety
3/5 Evidence to date for #SGLT2i:

The first of the two new classes of medications for type II diabetes to reduce ↘️ risk of CV #AdverseEvents and mortality

✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾‍💻

#T2DM #medsafety #FOAMed #MedEd #diabetes
Read 6 tweets
Nov 10, 2021
THREAD: Evidence for oseltamivir for #influenza prevention

1/6 Not much #flu last year, yet almost 14,000 BC residents were prescribed #oseltamivir (Tamiflu) for prevention

✅Flu guidelines bit.ly/3wwGJei

✅Systematic review of Tamiflu safety pubmed.ncbi.nlm.nih.gov/27246259
2/6 #Oseltamivir for prevention reduces ↘️ symptomatic influenza by 3%, (NNT=33) with an uncertain effect on asymptomatic #influenza

It likely has a central symptom reducing effect but may not reduce viral transmission
pubmed.ncbi.nlm.nih.gov/27246259

#Tamiflu #prescribing
3/6 #Oseltamivir won’t reduce the risk of developing influenza-like illness though it can make people feel better (i.e. fewer symptoms) and reduces ↘️ fever

There is not enough evidence to say it prevents death, hospitalizations, or flu complications
pubmed.ncbi.nlm.nih.gov/27246259
Read 7 tweets
Sep 19, 2021
THREAD: Medication adherence and shared decision-making

1/6 Our TI Letter 132 suggests a more democratic & ethical approach to shared decision-making: ti.ubc.ca/letter132

Here are 5⃣ highlights…

#MedEd #FOAMed #MedicationAdherence #PatientPreferences
2/6 Patients always retain right to say “no, thank you”🛑

Some pts may not want to accept their doctor's recommendations for a prescribed 💊 & have their own reasons to feel that it's not worth it for them.

This "intentional non-adherence" is a choice that should be respected
3/6 Studies have tested adherence aids

While these aids can improve adherence we don’t know if they lead to improved health outcomes 😕

See our TI Letter 132 on medication adherence: ti.ubc.ca/letter132 💻

#MedEd #FOAMed #MedicationAdherence #PatientPreferences
Read 7 tweets
Jul 12, 2021
THREAD: Shedding light on the risks of anticholinergic drugs

1/8 NEW information on risk of dementia and harm in the frail elderly. Free #BestEvidence webinar w/ Dr. Aaron Tejani @amtejani on July 14th

✅Registration: ti.ubc.ca/Anticholinergi…

#MedEd #deprescribing #medsafety
2/8 One of every 14 of the top 200 💊 prescribed in BC has anticholinergic properties

They include: amitriptyline, cyclobenzaprine, fluoxetine, quetiapine, sertraline, trazadone, venlafaxine, zopiclone, citalopram...

👉🏽More here ti.ubc.ca/2018/09/10/113…

#MedEd #deprescribing
3/8 What kinds of harms can #anticholingergics cause?
👉🏽Dry mouth 😦

❓Could your patient on an anticholinergic be experiencing bad breath/gum problems/tooth decay/trouble swallowing? 🤔

More here: ti.ubc.ca/2018/09/10/113…

#MedEd #deprescribing
Read 9 tweets
Jun 30, 2021
THREAD:5⃣things to know from 5 recent TI Therapeutics Letters👩🏽‍🔬

1/5: How to choose a good #mirtazapine dose? 🤔

Mirtazapine has a dose response 💊for harm but NOT for efficacy: harm ↗️ after 30mg/day but efficacy doesn't: bit.ly/361LU9E

#MedEd #deprescribing #ptsafety
2/5: Want to learn about recent @GovCanHealth #medsafety or international warnings for medications?

Read our Therapeutics Letter on international drug safety advisories: bit.ly/3wc0ar8 ⚠️ 💊

#drugsafety #SegPac #ptsafety
3/5: Do you like receiving feedback on your #prescribing?👩🏽‍⚕️💊

Read about Personal Prescribing Portraits: bit.ly/3hkf8WO

#MedEd #deprescribing
Read 6 tweets

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