In episode 80, Mike and James continue getting back to listener questions. We discuss such topics as glucose monitoring, ezetimibe, niacin, nebulised salbutamol and niacin with uncanny intuitive insight coupled with a degree of emotional sensitivity rarely encountered in podcasts. We then wake up and get Peter Loewen to help answer a difficult question on oral anticoagulants. Show notes 1) Self-monitoring of blood glucose ESMON BMJ 2008;336:1174-7 DiGEM BMJ 2008;336:1177-80 CADTH – thorough review of the  issue of glucose monitoring 2) Ezetimibe ENHANCE N Engl J Med 2008;358:1431-43 SEAS N Engl J Med 2008;359:1343-56 Cancer data N Engl J Med 2008;359:1357-66 3) Ezetimibe vs niacin – niacin better? ARBITER 6–HALTS N Engl J Med 2009;361:2113-22 4) Torcetrapib – worsens outcomes N Engl J Med 2007;357:2109-22 5) Niacin Coronary drug project Eur J Clin Pharmacol 1991;40 [Suppl 1]: S49-S51 6) Anticoagulation issues SARS (ASA, ASA+warf, ASA+ticlopidine) post ACS+stent NEJM 1998;339:1665-71 Registry of AF patients on OAC at time of PCI+stent JACC 2008;51:818–25 Registry of OAC patients (various indications) post PCI+DES J Intern Med 2008;264:472-80 Registry of OAC patients (various indications) post PCI+stent J Invasive Cardiol 2006;18:162-4

In our eighth installment, we discuss the initiation of hypertensive drug therapy. In recommending thiazide diuretics, we outline the evidence (e.g. ALLHAT trial) showing equivalence and the significantly lower yearly cost. We debate (politely this time) dosing and attempt to dispel the smokescreen of thiazide metabolic issues (e.g. blood glucose). The usual banter ensues around the challenges of monitoring therapeutic effect and the pseudo-logic of initiating combination drugs.

Show Notes

1) ALLHAT – no difference in CVD outcomes between thiazides, ACEI or CCBs in hypertensive patients treated for 4.9 years

2) Additional benefits of ACEIs/ARBs on renal outcomes in diabetic patients is unproven

Lancet 2005;366:2026-33

3) No evidence of superiority of CCBs or ACEs over thiazides for hypertenison in type 2 diabetics

Arch Intern Med 2005;165:1401-9