INTRODUCTION

Heart failure (HF) is a common cause of hospitalization, heart failure-related readmission, poor quality of life, and mortality. It also poses a substantial economic burden. The heart failure clinical practice guideline (HFCPG) was developed to provide evidence-based recommendations on the diagnosis and management of chronic HF with reduced ejection fraction (HFrEF) among adult Filipino patients in the outpatient setting for primary care physicians.

METHODS

The GRADE approach and an Evidence-to-Decision framework were used to evaluate the evidence and formulate recommendations. The strength and direction of each recommendation were determined through voting, with consensus reached if 75% of all CP members agreed.

RESULTS

The HFCPG provides 19 recommendations and one good practice statement in response to 14 identified clinical questions. Careful history-taking and physical examination, use of chest x-ray to detect cardiomegaly and/or pulmonary congestion, two-dimensional echocardiography for HF diagnosis, and baseline determination of serum sodium, potassium, and creatinine to guide management have been highly recommended; however, the 12-lead electrocardiogram should not be solely used for HF diagnosis. Judicious use of diuretics to relieve congestion, use of selected beta-blockers, renin-angiotensin-aldosterone blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors are strongly recommended for the treatment of HFrEF.

CONCLUSION

HFrEF is a complex condition that requires early recognition and careful management. Guideline-directed medical therapies, particularly the evidence-based pillars of treatment, are recommended, as well as early discussion of palliative care, timely determination of advanced heart failure and the need for referral to higher levels of care.

Human ; Heart Failure ; Outpatient Care ; Ambulatory Care ; Primary Health Care

BACKGROUND

Blood pressure (BP) is a vital sign that is essential in the management of hypertension, thus, there is a need for accurate measurement of BP. This will allow for proper diagnosis and management of hypertension preventing cardiovascular morbidity and mortality among Filipino patients.

METHODOLOGY

This validation study utilized the US Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) protocol for BP monitors. A total of eighty-five (85) participants had their BP measured using both the HEM 7156 and a validated aneroid sphygmomanometer. The same-sequential BP measurement was recommended to be used and a total of nine readings were collected per individual. The mean average of BP and standard deviation were extracted from the measurements. The AAMI/ESH/ISO recommends the use of certain criteria for individual BP readings (criterion 1) and individual participants (criterion 2). Appropriate statistical analysis was used for other demographic data.

RESULTS

The participants had an average age of 34 years, more than half were females, and not diagnosed with hypertension. Individuals who were diagnosed with hypertension had no other comorbidities and were on single pill only. The average arm circumference was 26.9 cm. Blood Pressure (BP) readings were adequate based on the protocol. Validity results showed that for criterion 1, systolic blood pressure (SBP) difference was 3.4 ± 7.4 mmHg, while diastolic blood pressure (DBP) was 2.0 ± 8.0 mmHg. The results for criterion 2 showed for SBP was 3.3 ± 5.3 mmHg, while DBP was 1.9 ± 6.6 mmHg. The results satisfied a passing grade on the validation protocol set by the AAMI/ESH/ISO.

CONCLUSION

This study showed that OMRON HEM 7156 is validated as a BP apparatus and may be recommended for Philippine use.

Human ; Hypertension

BACKGROUND Hypertension is the most common risk factor for cardiovascular disease in the Philippines. Despite the availability of antihypertensive medications that are effective, safe, and tolerated by Filipino patients, the numbers of uncontrolled hypertensives are still increasing. Several factors play in the poor control of blood pressure, particularly resistant hypertension and hyperactive sympathetic nervous system. Renal denervation therapy is a novel device that has been shown to lower blood pressure in patients with resistant and difficult-to-treat hypertension and is deemed safe in clinical trials. A Philippine Working Group composed of specialists in cardiology, hypertension, vascular surgery, and clinical epidemiology has come up with consensus statements in identifying patients who will benefit from the procedure. Locally, there is a need to have hypertension centers treating uncontrolled and resistant hypertension and offer renal denervation therapy to appropriate Filipino patients.
Blood Pressure

INTRODUCTION: Resistant hypertension is blood pressure (BP) that remains above target despite treatment with maximum doses of three antihypertensive drugs, which may include a diuretic. The prevalence of resistant hypertension is unknown, and there are no local studies in the Philippines concerning this condition. METHODS: A retrospective descriptive cohort study was conducted in the Hypertension Clinic of the Section of Hypertension of the Philippine General Hospital. A total of 51 patients were diagnosed with resistant hypertension, and charts were reviewed and analyzed. RESULTS: Majority of the patients were female (31 [60.8%]), with a mean age of 56.3 years. All of them presented with symptoms; the most common presenting symptoms were headache, exertional dyspnea, nape pain, dizziness, and easy fatigability. Of the 51 patients, 45% also had diabetes mellitus, 11.8% had dyslipidemia, and 7.8% had a previous history of preeclampsia. Approximately 35% of these patients were smokers. The average BP before referral to the section was 167/94 mm Hg. By this time, most patients will either be on a four-drug regimen (42.1%) or a three-drug regimen (36.8%). The median number of visits in the Hypertension Clinic before control of BP was three follow-ups, with the average BP being 119/71 mm Hg. The regimens of the patients with controlled BP are three-drug combination (36.4%), four-drug combination (36.4%), and five-drug combination (27.3%). CONCLUSION Early referral to a hypertension specialist may benefit a patient with resistant hypertension, decreasing the number of follow-up visits to control a patient’s BP. Patients with resistant hypertension may require four- to five-drug regimens, which may be needed to adequately control a patient’s BP.
Drug Combinations ; Hypertension

Background: The COVID-19 pandemic continues to afflict nations worldwide. The Philippines is no exception which has recorded more than 3 million cases as of December 2021 with children comprising 12% of total cases. Since the start of the pandemic, the Pediatric Infectious Disease Society of the Philippines (PIDSP) has been collecting data nationwide, through an online pediatric COVID-19 registry (SALVACION registry), to provide a better understanding of COVID-19 in children in the local setting. Methods: This was an ambispective cohort study of pediatric COVID-19 cases in the Philippines reported from March 2020 to December 2021. Data on clinical features, laboratory findings, disease severity, and treatment outcomes were voluntarily reported by physicians across the country. This study was approved by the Department of Health Single Joint Research Ethics Board. Results: As of December 30, 2021, there were 2,127 cases reported in the registry, with a median age of 5 years (interquartile range: 1-13 years) and mostly mild (41.9%) or moderate (24.5%) in severity. The top symptoms reported were fever (57.9%), cough (42.7%), coryza/colds (29.4%), anorexia (25.2%), and difficulty of breathing (23.1%). The most common comorbidities were hematologic-oncologic diseases (7.4%), neurologic diseases (7.0%) and surgical conditions (4.4%), while the most common coinfections were sepsis (6.3%), dengue fever (4.8%) and healthcare-associated pneumonia (2.1%). Significantly higher median CRP, procalcitonin, D-dimer, ferritin, transaminases and lactate dehydrogenase were seen among severe/critical cases compared to non-severe cases. There was a high frequency of antibiotic use (58%). Most cases recovered, although 172 deaths were reported with an 8.6% case fatality rate. The most common comorbidities in those who died were neurologic (15.7%), cardiac (12.8%) and hematologic (11.6%) diseases. Conclusion Children across all age groups are susceptible to COVID-19 and most cases are mild or moderate in severity. Among severe and critical cases, the most common comorbidities were neurologic, hematologic-oncologic and cardiac diseases. Most patients recovered with supportive management.
COVID-19 ; SARS-CoV-2 ; Child ; Registries ; Philippines

Dyslipidemia is a cardiovascular risk factor that is increasing in prevalence in the country. The need to treat and manage elevated cholesterol levels, both pharmacologic and non-pharmacologic, is of utmost importance. Different medical societies and groups bonded together to formulate the 2020 Philippine Clinical Practice Guidelines for dyslipidemia. The group raised nine clinical questions that are important in dyslipidemia management. A technical working group analyzed the clinical questions dealing with non-pharmacologic management, primary prevention for both non-diabetic and individuals with diabetes, familial hypercholesterolemia, secondary prevention, adverse events of statins and the use of other lipid parameters as measurement of risk for cardiovascular disease. Randomized controlled trials and meta-analyses were included in the GRADE-PRO analysis to come up with the statements answering the clinical questions. The statements were presented to a panel consisting of government agencies, members of the different medical societies, and private institutions, and the statements were voted upon to come up with the final statements of the 2020 practice guidelines. The 2020 CPG is aimed for the Filipino physician to confidently care for the individual with dyslipidemia and eventually lower his risk for cardiovascular disease.
Dyslipidemias ; Hyperlipoproteinemia Type II ; Diabetes Mellitus

BACKGROUND

Hypertension is one of the leading causes of cardiovascular morbidity and mortality in the Philippines. The prevalence rate of hypertension has been increasing, and this was associated with increasing comorbidities and poor control rates. The Philippine Heart Association-Council on Hypertension has been conducting the PRESYON studies since 1992 to determine the present hypertension rates. This updated PRESYON-4 aimed to know the latest numbers of hypertension cases in the country and to determine the awareness, treatment profile, and control rates of individuals afflicted with hypertension.

METHODS

PRESYON-4 is a randomized, prospective, multistage, stratified, nationwide survey conducted last January to April 2021. It included 3,437 participants; 2,796 subjects were adults aged 19 years or older, and the rest of the participants were 12 to 18 years old. The prevalence of hypertension was analyzed from the survey. Anthropometric measurements, risk factors, and comorbidity assessment were also determined.

RESULTS

The prevalence rate of hypertension in the latest survey is 37%, with more than half of the respondents aware of their disease. Utilizing the classification of the European guidelines for hypertension, 34% had grade 1 hypertension, with 26% of participants having isolated systolic hypertension. Individuals older than 50 years are aware of their elevated blood pressure (BP), but more females are aware of their disease compared with men. Current smoking and obesity are high in the hypertensive population, whereas diabetes mellitus and angina are the more common comorbidities. Most subjects utilize the oscillometric arm BP apparatus to monitor their BP. Angiotensin receptor blockers are the most used antihypertensive medication with a high compliance rate. However, there is poor control among treated patients with hypertension, as the control rate is only 39%. The prescription of a single drug is still prevalent among Filipino hypertensive individuals.

CONCLUSION

The point prevalence of hypertension in the country is at 37% based on the analysis. The need to manage risk factors such as obesity and smoking should be part of management. A multisectoral approach in the management of hypertension should be part of the strategy to lower hypertension in the country.

Hypertension ; prevalence ; Awareness ; Compliance

Introduction: Diabetes in the Philippines is a major and growing health issue. From its prevalence of 2.8 million in 2000, it was projected by the World Health Organization to reach 7.8 million by 2030. Glimepiride has been found to be effective and well-tolerated, as monotherapy and in combination with metformin, in managing glycemic levels among type II diabetes mellitus (T2DM) patients. This study aimed to assess the safety and efficacy of a sustained release (SR) fixed-dose combination (FDC) preparation of glimepiride and metformin in the treatment of Filipino patients with T2DM. Methods: This open-label, observational, multicenter, post-marketing study, conducted from April 2012 to December 2013, included 20 to 75-year-old patients with T2DM, presenting with 7% to 11% HbA1c or 110-250 mg/dL fasting blood sugar, insulin-naive, and in consideration for management with a glimepiride-metformin FDC. Baseline data were collected. Patients were prescribed with glimepiride-metformin FDC SR 2/500 mg/tab for a six-month treatment period. Follow-up data were collected on the third and the sixth month of treatment. Patients who missed one follow-up were included in population for safety analysis. Patients who completed both follow-up schedules make up the per-protocol population for efficacy analysis. Adverse events (AEs) were reported in frequencies and percentages. Repeated measures analysis of variance (ANOVA) was used for efficacy analysis on HbA1c and FBG data. Results: From 1,052 enrollees, 795 patients had sufficiently filled data forms and attended at least one follow-up schedule; this is the population whose data was analyzed for this study. Fifty-nine AEs were reported; only 21 incidents of hypoglycemia were assessed to be definitely, probably, or possibly related to the study drug. Repeated measure ANOVA showed that the mean ± SD HbA1c at month three (7.15 ± 1.22%) and month six (6.80 ± 1.17%) were significantly lower than baseline (8.67 ± 1.10%). The mean ± SD FBG at month three (133.20 ± 35.46 mg/dL) and month six (122.47 ± 29.34 mg/dL) were also significantly lower than baseline (176.85 ± 41.24 mg/dL). The differences in HbA1c and FBG changes between those with concomitant OAD and those without were non-significant. Conclusion Fixed-dose combination of glimepiridemetformin is a drug with a tolerable profile and favorable benefits in treating patients with T2DM.
Metformin

Introduction: Resistant hypertension (RH) is defined as a blood pressure (BP) reading that remains above goal despite concurrent use of three optimally dosed antihypertensives of different classes, including a diuretic. Spironolactone, a mineralocorticoid receptor antagonist, has shown significant benefit in reduction of BP in recent trials and is used empirically as an add-on therapy for RH. The researchers’ objective is to evaluate the BP-lowering efficacy of spironolactone in patients with resistant hypertension. Methods: A meta-analysis was performed on randomized controlled trials (RCTs) comparing office or home BP reduction using spironolactone with placebo or an alternative drug regimen on top of standard-triple drug therapy among patients with RH. The study was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Five RCTs were included comprising a total of 662 patients. Three of these studies were found to have low risk of bias while two had unclear risk of bias. Compared to placebo, the addition of spironolactone significantly decreased office systolic BP (weighted mean difference [WMD]= -16.33, 95% confidence interval [CI]=-24.68 to -7.97, P=0.0001) and office diastolic BP (WMD=-6.12, 95% CI= -9.35 to -2.89, P=0.0002). Compared to an alternative drug regimen, additional spironolactone resulted in a significantly greater reduction in office systolic BP (WMD=-4.58mmHg, 95% CI=-7.19, -1.97, P= 0.0006) and home systolic BP (WMD= -4.33, 95% CI= 5.55, -3.12, P< 0.00001); while the addition of spironolactone had no significant difference compared to an alternative drug regimen in reducing office diastolic BP (WMD=-3.35, 95% CI=-12.08 to +5.38, P=0.45) and home diastolic BP (WMD= 0.00, 95 % CI=-0.73 to 0.73, P=1.0). Conclusion Spironolactone, when added to triple-drug anti-hypertensive therapy, showed significant reduction of systolic office and home BP. It should be considered as the add-on medication of choice for BP reduction in patients with RH.
Antihypertensive Agents ; Spironolactone ; Blood Pressure

BACKGROUND: Insulin glulisine  is a  new  rapid-acting insulin  analogue.  Currently,  few  data   are   available on its safety and tolerability among patients in the Asia-Pacific   region.
OBJECTIVES:
Primary Objective: To assess the safety and tolerability of insulin glulisine as part of an insulin treatment   regimen   in   Filipinos   with   diabetes
Secondary  Objectives:
1.    To compare the change in glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG) and post-prandial blood glucose (PPBG) levels at baseline and after  three  and  six months on an insulin treatment regimen with insulin  glulisine
2.    To measure patients' level of  satisfaction  in  using   the   Insulin   glulisine  pen
METHODS: This was a multicenter, observational, post- marketing  surveillance  study   of   adult   patients   (18   to Results: Among 1,805 patients included, 132 (7.31%) experienced hypoglycemia. The overall incidence of adverse events other than hypoglycemia was 0.78%. There  was  a  significant  reduction  in   baseline  levels   of HbA1c,  FBG  and  PPBG  during  the  follow-up  visits  at third and sixth months (all p<0.0001). Patient satisfaction  with  using  the  pen  was  good  to    excellent.
CONCLUSION: This post-marketing surveillance study demonstrates the safety and tolerability of  insulin  glulisine  when  used   as   part   of   an   insulin   regimen in an actual clinical setting for the management of diabetes among Filipino  patients.  Insulin  glulisine  as  part of  a   diabetes  treatment  regimen  was   effective  in improving glycemic  parameters.  The  glulisine  pen  was   also   well   tolerated   and   accepted   by patients.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Hemoglobin A, Glycosylated ; Insulin Glulisine ; Diabetes Mellitus, Type 2 ; Insulin, Short-acting ; Excipients ; Fasting ; Insulin ; Hypoglycemia