You guys our whipping out the content-hard to keep up with family, work, and riding :) It’s been extremely beneficial/impactful to hear some expert critical appraisal on these older trials-Thank you!! Anyhow for those of us with limited RAM to immediately recall the nuances of these trials over the longer term, it seems like a main theme that has emerged is that in the presence of LV dysfunction offloading the LV is THE primary therapy when it comes to utilizing approved GDMT agents? ACE inhibitors very beneficial, BB not so much (since their poor antihypertensive agents?), aldosterone antagonist yes but with the benefit most notable for those with higher systolic readings. Just looked at the paradigm trial in NEJM to see if SBP was lower in the treatment V. Control group and it was by 3.2mmHg. Authors note that this didn’t effect the results as when the blood pressure difference was ‘modeled as a time dependent co-variate, it was not a determinant of the incremental benefit”-I would love an opinion here from you folks when you get there!
*(BB benefits also muted/canceled in some patients by the reduction of HR that is actually needed to maintain CO)
You guys our whipping out the content-hard to keep up with family, work, and riding :) It’s been extremely beneficial/impactful to hear some expert critical appraisal on these older trials-Thank you!! Anyhow for those of us with limited RAM to immediately recall the nuances of these trials over the longer term, it seems like a main theme that has emerged is that in the presence of LV dysfunction offloading the LV is THE primary therapy when it comes to utilizing approved GDMT agents? ACE inhibitors very beneficial, BB not so much (since their poor antihypertensive agents?), aldosterone antagonist yes but with the benefit most notable for those with higher systolic readings. Just looked at the paradigm trial in NEJM to see if SBP was lower in the treatment V. Control group and it was by 3.2mmHg. Authors note that this didn’t effect the results as when the blood pressure difference was ‘modeled as a time dependent co-variate, it was not a determinant of the incremental benefit”-I would love an opinion here from you folks when you get there!