Cultivate your medical knowledge with our curated collection of cutting-edge articles. Explore the latest research, insights, and breakthroughs in the field of healthcare in our dedicated medical topics section.

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Medical Topics

Postoperative neuropathic pain is one of the most dreadful complications following lumbar spine surgeries. Owing to the similarities in the pathophysiological and biochemical mechanisms underlying epilepsy and neuropathic pain, many antiepileptic drugs (AEDs) like pregabalin and gabapentin are being used in the treatment of post-operative neuropathic pain.It is important to mention that Gabapentin 900mg/day led to the lowest VAS score (Pain score) and was the best in its opioid sparing effect followed by other concentrations&nbsp; of Gabapentin (1200mg, 600mg, and 300mg) &amp; Pregabalins (150mg &amp; 75mg), respectively with no significant differences in adverse events in spine Surgeries.
Reference:&nbsp; Garg RN, Vaje S, Patil H, Bajaj S. A prospective and observational study to assess the efficacy of pregabalin versus gabapentin in relieving early post operative neuropathic pain with respect to clinical and functional outcomes in patients undergoing open lumbar discectomy surgery. International Journal of Research in Orthopaedics. 2023;10(1):57–63. doi:10.18203/issn.2455-4510.intjresorthop20234039&nbsp;
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Management of Perioperative Pain Control After Spine Surgery

Postoperative pain is influenced by various factors, including the duration and site of the operation, the amount of manipulation involved, and the individualized perception of pain. More than two-thirds of patients who undergo total joint arthroplasty experience severe postoperative pain. Many patients suffer from extreme pain after total knee arthroplasty (TKA) and total hip arthroplasty (THA), especially in the first 2 weeks. Enhanced pain control after arthroplasty is related to shorter rehabilitation time, decreased complications, and improved patient satisfaction. The number of joint arthroplasty surgeries have increased worldwide, with more than one million arthroplasties performed each year in the United States. Considering the increased number of arthroplasty cases, it seems necessary to identify the latest approaches for postoperative pain control. Duloxetine, a selective serotonin and norepinephrine reuptake inhibitor (SNRI), has been approved for treating depression,
anxiety, and post-traumatic stress disorders by the US Food and Drug Administration (FDA). It has also been
approved to treat diabetic neuropathic pain and fibromyalgia. Several studies has shown the role of duloxetine in reducing the pain caused by knee and hip osteoarthritis, two systematic reviews and meta-analyses have confirmed duloxetine’s analgesic and opioid-sparing role postoperatively. In conclusion, Duloxetine 30mg/60mg shows moderate opioid sparing effects and statistically significant reduction in pain scores with no significant difference in the prevalence of side effects versus Placebo.
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Reference: Azimi A, Hooshmand E, Mafi AA, Tabatabaei F-S. Effect of duloxetine on opioid consumption and pain after total knee and hip arthroplasty: A systematic review and meta-analysis of randomized clinical trials. Pain Medicine. 2023;24(9):1035–45. doi:10.1093/pm/pnad045&nbsp;
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Medicines and Opioids Consumption Effect on Post-operative Pain

Postoperative pain control is a critical component of comprehensive postsurgical patient care, as it affects patient satisfaction and operative outcomes and can result in pathophysiologic neural alterations that evolve into chronic pain syndromes. Tissue trauma resulting from surgery is thought to lead to both central and peripheral nerve sensitization, resulting in an activity-dependent increase in spinal neurons excitation and a decreased threshold of nociceptive afferents, respectively.&nbsp;
Historically, opioids have been the preferred drug of choice for the management of postoperative pain following joint arthroplasty. However, when used in excess, opioids can lead to deleterious side effects and have the potential for both addiction and abuse. These risks are particularly important in orthopaedics given that orthopaedic surgeons are highest prescribers amongst all surgeons.
Considering the concerns surrounding excessive opioid use, multimodal analgesic regimens utilizing a combination of opioid and nonopioid analgesic drugs targeting different sites within the central and peripheral nervous system have emerged as the new standard in managing postoperative pain. Among commonly used interventions, such as acetaminophen and nonsteroidal anti-inflammatory drugs, there is a growing body of evidence suggesting that duloxetine is used in the management of postoperative pain. The 60mg concentration of Duloxetine significantly reduced pain at rest and at movement as well as opioid consumption at 48 and 72hrs after Knee or Hip Replacement operations.
Reference: Jones IA, Talehakimi A, Murphy LS, Wang JC, Piple AS, Christ AB, et al. Duloxetine for postoperative pain control following knee or hip replacement: A systematic review and meta-analysis. Arthroplasty Today. 2023 Apr;20:101097. doi:10.1016/j.artd.2023.101097&nbsp;
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Post-operative Pain Control after Knee Replacement

Chronic sciatica (CS), like most neuropathic pain states, is often resistant to simple treatment regimens. Chronic sciatica is sciatica lasting longer than 3 months. Neuropathic pain states are typically managed by super-adding anticonvulsant drugs onto simple drug regimens. The drugs most used are gabapentin (GBP) or pregabalin (PGB). Chronic sciatica has therefore been increasingly treated with super-added GBP or PGB. GBP led to superior Visual analog pain intensity scale reduction with fewer and less sever adverse events than PGB. In addition to this, it is important to mention that GBP should be commenced before PGBs to permit optimal crossover of medicines.
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Reference:
Robertson K, Marshman L, Plummer D, Downs E. Effect of Gabapentin vs Pregabalin on Pain Intensity in Adults With Chronic Sciatica. JAMA Neurology. 2019;76(1):28.
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Trends in Pain Management of Chronic Sciatica

In patients with both chronic liver disease and type 2 diabetes who consistently followed their treatment regimen, GLP-1 agonists could lead to a reduced risk of major adverse liver outcomes (MALO). The impact of glucagon-like peptide-1 receptor (GLP1) agonists on hard clinical outcomes in patients with chronic liver diseases of any cause and concurrent type 2 diabetes is uncertain, despite their potential for resolving metabolic dysfunction-associated steatohepatitis. GLP1 agonists could potentially serve as a treatment option to lower the risk of MALO in patients with type 2 diabetes and any form of chronic liver disease who adhere to the treatment regimen over time. However, confirmation of these findings would require validation through randomized clinical trials.&nbsp;
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Reference: Wester A, Shang Y, Toresson Grip E, et alGlucagon-like peptide-1 receptor agonists and risk of major adverse liver outcomes in patients with chronic liver disease and type 2 diabetesGut Published Online First: 22 January 2024. doi: 10.1136/gutjnl-2023-330962.&nbsp;

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GLP-1 Agonists Reduce Risk for Severe Liver Disease

SGLT2 inhibitors were linked to a reduced likelihood of composite anemia outcomes, particularly instances of anemia events.&nbsp;
This retrospective cohort study, indicated that using SGLT2 inhibitors was associated with a 19% reduced risk of composite anemia outcomes compared to the use of GLP-1 RA.&nbsp;
The results remained consistent across various SGLT2 inhibitors, implying a class-wide effect of anemia benefits associated with SGLT2 inhibitors.&nbsp;
These main findings were supported by alterations in hematological laboratory parameters, revealing significant distinctions between the SGLT2 inhibitor and GLP-1 RA groups over the three-year monitoring period.&nbsp;
The similarity in glycemic control and kidney function changes observed in both the SGLT2 inhibitor and GLP-1 RA groups suggest that mechanisms possibly responsible for the decreased incidence of anemia with SGLT2 inhibitor use are likely independent of these factors.&nbsp;
SGLT2 inhibitors may be considered as an adjunct therapy to mitigate the occurrence of mitigate the occurrence of anemia in patients with type 2 diabetes and chronic kidney disease.&nbsp;
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Reference: Hu J, et al. Use of SGLT2 Inhibitors vs GLP-1 RAs and Anemia in Patients With Diabetes and CKD. JAMA Netw Open. 2024;7(3):e240946.&nbsp;

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Diabetes Treatment and Risk of Anemia in Patients with Diabetes and CKD 

Metformin for type 2 diabetes mellitus (T2DM) patients is linked to a decreased risk of experiencing severe diabetic nephropathy and major cardiovascular events.&nbsp;
For T2DM patients with compromised kidney functions, maintaining metformin therapy is connected to reduced risk of major kidney and cardiovascular events compared with non-metformin user or discontinued user.&nbsp;
Metformin usage among T2DM patients, regardless of their renal functions variation, consistently shows a lower risk of severe diabetic nephropathy (DN), major adverse cardiovascular events (MACE), and major adverse kidney events (MAKE) compared with the control cohort.&nbsp;
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Reference: Yongjin Yi, et al. Impact of metformin on cardiovascular and kidney outcome based on kidney function status in type 2 diabetic patients: a multicentric, retrospective cohort study. Sci Rep 14, 2081 (2024).&nbsp;

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Impact of Metformin on Cardiovascular and Kidney Outcomes in Type 2 Diabetic Patients 

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ADA 2025 Guidelines: Navigating the New Diagnostic Algorithm for MASLD 

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ADA 2025 Guidelines- Management of MASLD:

ADA 2025 Guidelines- Management of MASLD

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Updated Vaccination Recommendations for People with Multiple Sclerosis

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MS
Multiple Sclerosis
CNS
Cognitive Impairment

A New Framework for Cognitive Impairment in MS: 5 Phenotypes Based on Severity and Domain

The evolving understanding of multiple sclerosis (MS) continues to reshape our approach to its diagnosis and management. A landmark article by Giovannoni and colleagues, published in Therapeutic Advances in Neurological Disorders, introduces the concept of "smouldering MS", positing it as the fundamental driver of disease progression. Below, we distill the key insights and clinical implications.
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Understanding Smouldering MS
Smouldering MS is characterized by persistent disease activity, independent of clinical relapses or visible MRI lesions. The authors propose that this chronic, underlying pathology may be the "real MS," responsible for long-term disability and progressive neurodegeneration.
Key Features Include:
<ul style="margin-top: 0in;" type="disc">
<li>Chronic Active Lesions: Also called "rim lesions," these slowly expanding lesions show sustained demyelination and axonal injury.</li>
<li>Diffuse Inflammation: Microglial and astrocytic activation in both gray and white matter drives progressive damage.</li>
<li>Cortical Demyelination: Subtle cortical damage, associated with cognitive and physical decline, is often missed on conventional MRI.</li>
<li>Accelerated Brain Atrophy: Smouldering MS is linked to faster brain volume loss, a key marker of neurodegeneration.</li>
</ul>
This paradigm challenges traditional notions that focus primarily on relapsing-remitting MS (RRMS) and emphasizes the importance of identifying smouldering disease activity early.
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Diagnostic and Monitoring Challenges
Traditional MRI metrics such as gadolinium-enhancing lesions and T2 lesion count may not adequately capture smouldering MS. Instead, the authors advocate for advanced imaging techniques and biomarkers to assess:
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l2 level1 lfo2; tab-stops: list .5in;">Chronic lesion activity: Better captured by techniques like susceptibility-weighted imaging (SWI).</li>
<li class="MsoNormal" style="mso-list: l2 level1 lfo2; tab-stops: list .5in;">Diffuse neurodegeneration: Measured through cortical atrophy and brain volume loss.</li>
<li class="MsoNormal" style="mso-list: l2 level1 lfo2; tab-stops: list .5in;">Microglial activation: Potentially detectable with PET imaging or other emerging modalities.</li>
</ul>
Neurologists should remain vigilant for subtle signs of progression that might not correlate with clinical relapses.
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Therapeutic Implications
Smouldering MS necessitates a paradigm shift in treatment approaches:
<ol style="margin-top: 0in;" start="1" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo3; tab-stops: list .5in;">Early and Aggressive Intervention Delaying treatment risks missing the window to address the insidious damage associated with smouldering MS. Starting therapy early, even in clinically silent phases, may mitigate long-term disability.</li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo3; tab-stops: list .5in;">Neuroprotective Strategies Therapies with potential neuroprotective effects, such as sphingosine-1-phosphate (S1P) receptor modulators (e.g., fingolimod), could play a critical role in targeting smouldering disease mechanisms.</li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo3; tab-stops: list .5in;">Emerging Treatments Research into agents promoting remyelination, axonal repair, and microglial modulation is essential to address this unmet need.</li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo3; tab-stops: list .5in;">Redefining Treatment Goals Beyond controlling inflammation, therapies should aim to reduce brain atrophy and slow neurodegeneration, which better reflect smouldering activity.</li>
</ol>
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Key Takeaways for Clinical Practice
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo4; tab-stops: list .5in;">Adopt a Broader Lens: Monitor for neurodegeneration and subtle signs of progression, even in the absence of clinical relapses.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo4; tab-stops: list .5in;">Refine Treatment Selection: Consider therapies with neuroprotective and disease-modifying potential to address smouldering MS.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo4; tab-stops: list .5in;">Communicate with Patients: Educate patients about the importance of long-term, proactive management to prevent silent progression.</li>
</ul>
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For the full article, visit: <a href="https://doi.org/10.1177/17562864211066751">Ther Adv Neurol Disord. 2022 Jan 25;15:17562864211066751</a>.

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Smouldering MS: The fundamental driver of disease progression

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Newsletter: Unveiling the Enigma of CD20-Positive CD8 T Cells 

Unveiling the Enigma of CD20-Positive CD8 T Cells 

<h3 class="MsoNormal" style="text-align: center;" align="center">Migraine: The Hidden Burden Across the Globe Insights from the OVERCOME (International) Study</h3>

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Migraine: The Hidden Burden Across the Globe
Insights from the OVERCOME (International) Study

Migraine: The Hidden Burden Across the Globe Insights from the OVERCOME (International) Study

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Sleep Under Siege: Understanding the Impact of Sleep Disturbances in Older Adults During and After the Pandemic 

The Impact of Trauma on Long-Term Mental Health: A Call for Follow-Up Care
Recent research sheds light on the significant and long-lasting mental health challenges faced by trauma patients.
A study by Lai Kin Yaw et al., published in JAMA Network Open, reveals that new mental health conditions often develop in patients after traumatic injuries, with these conditions being linked to increased risks of trauma readmissions, suicides, and all-cause mortality.
Key Findings:
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Prevalence of Mental Health Conditions Post-Trauma: Among 29,191 adult trauma patients, 11.3% developed new mental health conditions after their trauma admission. The conditions primarily included drug dependence in 8.2%, neurotic disorders (including PTSD) in 5.4%, anxiety disorders, and mood disorders.  </li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Long-Term Impact: Developing a new mental health condition was associated with:</li>
<ul style="margin-top: 0in;" type="circle">
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Increased trauma readmissions: Patients with new-onset mental health conditions were 30% more likely to experience repeated trauma admissions.</li>
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Higher risk of suicide: There was a 3.14-fold increase in the likelihood of suicide by hanging or drug overdose.</li>
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Elevated all-cause mortality: These patients were 24% more likely to die from any cause, emphasizing the severe impact of mental health deterioration following trauma.</li>
</ul>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Vulnerable Subgroups: Certain factors were found to increase the risk of developing mental health issues after trauma, including:</li>
<ul style="margin-top: 0in;" type="circle">
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Younger age</li>
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Unemployment</li>
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Single or divorced status</li>
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Indigenous ethnicity</li>
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Lower socioeconomic status</li>
<li class="MsoNormal" style="mso-list: l0 level2 lfo1; tab-stops: list 1.0in;">Traumatic brain injury</li>
</ul>
</ul>
Clinical Implications:
This study underscores the critical need for mental health follow-up in trauma patients, especially those from vulnerable subgroups. Given the high incidence of new mental health conditions following trauma and their association with adverse long-term outcomes, mental health care should be considered an essential component of trauma recovery.
Recommendations for Healthcare Providers:
<ol style="margin-top: 0in;" start="1" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo2; tab-stops: list .5in;">Early Identification: Screen for emerging mental health conditions during hospital stays and post-discharge.</li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo2; tab-stops: list .5in;">Targeted Interventions: Focus on high-risk groups such as younger patients, those with lower socioeconomic status, and individuals with traumatic brain injuries.</li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo2; tab-stops: list .5in;">Long-Term Monitoring: Offer regular follow-ups for mental health assessments, considering the multiphasic trajectory of trauma recovery.</li>
</ol>
Takeaway for Practice:
Mental health conditions after trauma are not isolated to PTSD but also include drug dependence and mood disorders. Addressing these conditions promptly can improve long-term health outcomes and reduce the risk of further trauma, suicide, and premature death.
For optimal recovery, clinicians should integrate mental health care into the treatment plan for trauma patients.
For More Information:
We encourage you to review the full study for more insights on managing post-trauma mental health and its long-term effects: Yaw, L.K., Burrell, M., Ho, K.M. "Long-Term Outcomes and Determinants of New-Onset Mental Health Conditions After Trauma." JAMA Network Open, March 2025.
<a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831185">https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831185</a>

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The Impact of Trauma on Long-Term Mental Health: A Call for Follow-Up Care

Real-World Impact of DOAC Switching in NVAF Patients
Atrial fibrillation (AF) is a common heart rhythm disorder linked to increased stroke risk, especially in its non-valvular form (NVAF). DOACs (e.g., apixaban, rivaroxaban) are now standard for stroke prevention in NVAF, replacing older treatments like warfarin. However, switching between DOACs is frequent in practice, raising questions about its impact on stroke/systemic embolism (SE) and major bleeding (MB) risk. This real-world study examines those risks in NVAF patients switching between apixaban and rivaroxaban compared to those continuing their initial DOAC. This US claims database study analyzed privately insured NVAF patients who initiated apixaban or rivaroxaban between 2013 and 2021. Patients were classified as "switchers" or "continuers" (assigned a pseudo-switch date). Propensity score matching (PSM) balanced baseline characteristics between groups. Outcomes (stroke/SE and major bleeding) were compared using Cox proportional hazards models, with a sensitivity analysis conducted on standard-dose patients. The results showed that: Switching from apixaban to rivaroxaban significantly increased the risks of both stroke/SE (HR 1.99) and major bleeding (HR 1.80), with incidence rates of 1.53 vs. 0.75 and 4.59 vs. 2.44 per 100 person-years, respectively. Conversely, switching from rivaroxaban to apixaban did not significantly change stroke/SE risk (HR 0.74) but significantly&nbsp;reduced&nbsp;major bleeding risk (HR 0.49), with corresponding incidence rates of 0.61 vs. 0.78 and 2.01 vs. 3.89. These findings held true in a sensitivity analysis of standard-dose patients. This study demonstrates that switching from apixaban to rivaroxaban increases stroke/SE and bleeding risks, while switching from rivaroxaban to apixaban may&nbsp;lower&nbsp;bleeding risk without increasing stroke/SE risk. These findings, consistent even among standard-dose patients, can inform clinical decision-making regarding DOAC switches in NVAF. Further research is needed to understand the motivations behind these switches.  
Reference: <a href="https://pdfs.semanticscholar.org/b1fb/8e8d21e4dc003744e8b2d6cd8b173be80513.pdf#:~:text=We%20aimed%20to%20evaluate%20stroke%2Fsystemic%20em-bolism%20%28SE%29%20and,patients%20continuing%20or%20switching%20to%20different%20oral%20anticoagulants.">Deitelzweig S, Kang A, Jiang J, Gao C, Luo X, Nipun Atreja, et al. Clinical Impact of Switching or Continuation of Apixaban or Rivaroxaban among Patients with Non-Valvular Atrial Fibrillation. Journal of Clinical Medicine. 2024 Feb 14;13(4):1073–3.</a>  
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Real-World Impact of DOAC Switching in NVAF Patients

<h1 class="MsoNormal">Guidelines Comparison The 2024 ESC guidelines introduce a simplified, three-tiered system:</h1>
Non-elevated: &lt;120/70 mmHg (no drug treatment recommended)
Elevated: 120-139/70-89 mmHg (drug treatment considered based on CVD risk and follow-up BP)
Hypertension: ≥140/90 mmHg (prompt treatment recommended for all)
The ESC avoids terms like "normal" or "optimal" because even in the lowest BP range, CVD risk still increases with rising BP. They retain the traditional ≥140/90 mmHg threshold for hypertension as this is where treatment clearly shows net benefit. The "elevated" category acknowledges that treatment can benefit higher-risk individuals even below this traditional threshold, based on recent trial data.
Here's a summary comparison:
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<td style="border: none; border-bottom: solid #7F7F7F 1.0pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 128; mso-border-bottom-alt: solid #7F7F7F .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Feature
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ESC 2024
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ESH 2023
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ACC/AHA 2017
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<td style="border: none; border-right: solid #7F7F7F 1.0pt; mso-border-right-themecolor: text1; mso-border-right-themetint: 128; mso-border-right-alt: solid #7F7F7F .5pt; background: #F2F2F2; mso-background-themecolor: background1; mso-background-themeshade: 242; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
BP Classification
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3 tiers: Non-elevated, Elevated, Hypertension
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6 tiers: Optimal, Normal, High-normal, Grade 1-3 Hypertension
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4 tiers: Normal, Elevated, Hypertension Stage 1-2
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Hypertension Threshold
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≥140/90 mmHg
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≥140/90 mmHg (but treatment at ≥160 mmHg for &gt;80 years old)
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<td style="padding: 0in 5.4pt 0in 5.4pt;" valign="top">
≈130/80 mmHg (for high-risk individuals)
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</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border: none; border-right: solid #7F7F7F 1.0pt; mso-border-right-themecolor: text1; mso-border-right-themetint: 128; mso-border-right-alt: solid #7F7F7F .5pt; background: #F2F2F2; mso-background-themecolor: background1; mso-background-themeshade: 242; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Staging Based on Complications
</td>
<td style="background: #F2F2F2; mso-background-themecolor: background1; mso-background-themeshade: 242; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
No
</td>
<td style="background: #F2F2F2; mso-background-themecolor: background1; mso-background-themeshade: 242; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Yes
</td>
<td style="background: #F2F2F2; mso-background-themecolor: background1; mso-background-themeshade: 242; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
No
</td>
</tr>
<tr style="mso-yfti-irow: 3; mso-yfti-lastrow: yes;">
<td style="border: none; border-right: solid #7F7F7F 1.0pt; mso-border-right-themecolor: text1; mso-border-right-themetint: 128; mso-border-right-alt: solid #7F7F7F .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Rationale
</td>
<td style="padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Simplified for treatment decisions; acknowledges risk continuum
</td>
<td style="padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Detailed classification and staging for prognosis
</td>
<td style="padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Lower threshold reflecting earlier trial data in high-risk individuals
&nbsp;
</td>
</tr>
</tbody>
</table>
The ESC 2024 guidelines prioritize simplicity and treatment decisions, while the ESH 2023 guidelines provide a more prognostic classification. The ACC/AHA 2017 guidelines represent an earlier approach with a lower hypertension threshold based on then-available data.
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Comparison of Resistant Hypertension Guidelines (ESC 2024, ESH 2023, ACC/AHA 2017)
<table class="MsoTable15Plain3" style="border-collapse: collapse; mso-yfti-tbllook: 1184; mso-padding-alt: 0in 5.4pt 0in 5.4pt;" border="0" cellspacing="0" cellpadding="0">
<tbody>
<tr style="mso-yfti-irow: -1; mso-yfti-firstrow: yes; mso-yfti-lastfirstrow: yes;">
<td style="border: none; border-bottom: solid #7F7F7F 1.0pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 128; mso-border-bottom-alt: solid #7F7F7F .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Feature
</td>
<td style="border: none; border-bottom: solid #7F7F7F 1.0pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 128; mso-border-bottom-alt: solid #7F7F7F .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
ESC 2024
</td>
<td style="border: none; border-bottom: solid #7F7F7F 1.0pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 128; mso-border-bottom-alt: solid #7F7F7F .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
ESH 2023
</td>
<td style="border: none; border-bottom: solid #7F7F7F 1.0pt; mso-border-bottom-themecolor: text1; mso-border-bottom-themetint: 128; mso-border-bottom-alt: solid #7F7F7F .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
ACC/AHA 2017
</td>
</tr>
<tr style="mso-yfti-irow: 0;">
<td style="border: none; border-right: solid #7F7F7F 1.0pt; mso-border-right-themecolor: text1; mso-border-right-themetint: 128; mso-border-right-alt: solid #7F7F7F .5pt; background: #F2F2F2; mso-background-themecolor: background1; mso-background-themeshade: 242; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Spironolactone
</td>
<td style="background: #F2F2F2; mso-background-themecolor: background1; mso-background-themeshade: 242; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Class IIa
</td>
<td style="background: #F2F2F2; mso-background-themecolor: background1; mso-background-themeshade: 242; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Class II
</td>
<td style="background: #F2F2F2; mso-background-themecolor: background1; mso-background-themeshade: 242; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Favored, no formal recommendation
</td>
</tr>
<tr style="mso-yfti-irow: 1; mso-yfti-lastrow: yes;">
<td style="border: none; border-right: solid #7F7F7F 1.0pt; mso-border-right-themecolor: text1; mso-border-right-themetint: 128; mso-border-right-alt: solid #7F7F7F .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Renal Denervation
</td>
<td style="padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Consider if: Performed at experienced center after risk/benefit discussion and multidisciplinary assessment Class IIb) Do not use if: eGFR &lt; 40 mL/min/1.73m² (Class III)
</td>
<td style="padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Consider if eGFR &gt; 40 mL/min/1.73m² (Class II)
</td>
<td style="padding: 0in 5.4pt 0in 5.4pt;" valign="top">
Not addressed
</td>
</tr>
</tbody>
</table>
 Reference:
<a href="https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.124.24173?rfr_dat=cr_pub++0pubmed&amp;url_ver=Z39.88-2003&amp;rfr_id=ori%3Arid%3Acrossref.org">McCarthy CP, Bruno RM, Rahimi K, Touyz RM, McEvoy JW. What Is New and Different in the 2024 European Society of Cardiology Guidelines for the Management of Elevated Blood Pressure and Hypertension? Hypertension. 2024 Dec 31.</a>
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Cardiology Guidelines Comparison

The European Society of Cardiology (ESC) has released the 2024 Guidelines for the Management of Elevated Blood Pressure and Hypertension, introducing updated recommendations to enhance patient outcomes and optimize clinical practice.
&nbsp;Key Updates:
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Revised Blood Pressure Targets: Stricter control recommendations based on patient age and cardiovascular risk.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Early Combination Therapy: Dual or triple therapy is now emphasized as first-line treatment for better efficacy.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Lifestyle Modifications: Stronger reinforcement of diet, exercise, and sodium reduction in hypertension management.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Advanced Blood Pressure Monitoring: Greater focus on home and ambulatory monitoring for accurate diagnosis and treatment adjustments.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Special Population Considerations: Tailored treatment approaches for elderly patients, individuals with diabetes, and pregnant women.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Comprehensive Cardiovascular Risk Management: Hypertension treatment is now integrated into broader cardiovascular disease prevention strategies.  </li>
</ul>
For further details, refer to the full 2024 ESC Guidelines on Hypertension: &nbsp;<a href="https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Elevated-Blood-Pressure-and-Hypertension" target="_new">ESC 2024 Hypertension Guidelines</a>
Reference: European Society of Cardiology. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024. Available from: <a href="https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Elevated-Blood-Pressure-and-Hypertension" target="_new">https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Elevated-Blood-Pressure-and-Hypertension</a>

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2024 ESC Guidelines for the Management of Hypertension – Key Updates

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2024 ESC Guidelines for the Management of Atrial Fibrillation – Key Updates 

The European Society of Cardiology (ESC) has released the 2023 Focused Update to the 2021 Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. This update integrates the latest clinical evidence to enhance patient care and optimize treatment strategies.
&nbsp;Key Updates:
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Refined Heart Failure Classification: Emphasizing Heart Failure with Improved Ejection Fraction (HFimpEF) as a distinct category.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Updated Pharmacological Recommendations: Stronger endorsement of SGLT2 inhibitors as foundational therapy for all heart failure patients, regardless of ejection fraction.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Personalized Treatment Strategies: Tailored therapeutic approaches based on biomarkers, imaging, and genetic considerations.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Enhanced Use of Implantable Devices: Expanded indications for implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) in selected patients.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Acute Heart Failure Management: Revised recommendations for diuretic strategies, vasodilators, and inotropic support to improve acute-phase treatment.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Focus on Comorbidities: Updated guidance on managing iron deficiency, kidney disease, and diabetes in heart failure patients.</li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: list .5in;">Telemedicine and Remote Monitoring: Encouragement of digital health solutions for early intervention and long-term management.</li>
</ul>
For further details, refer to the full 2023 ESC Focused Update on Heart Failure: <a href="https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines">&nbsp;ESC 2023 Heart Failure Guidelines Update</a>
Reference: European Society of Cardiology. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023. Available from:<a href="file:///C:/Users/nader.nokrachi/Downloads/%20https:/www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines%20"> https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines</a> 
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2023 Focused Update of the ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure – Key Updates

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Cognitive Impairment in Major Depressive Disorder (MDD) 

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