No abstract

BACKGROUND: Chronic kidney disease (CKD) is a global health burden in the world. One of the complications of CKD is proteinuria. Candesartan is a drug that is often used in CKD patients to improve proteinuria. There are several studies that suggest that using a higher dose of candesartan can further improve its effectiveness in reducing proteinuria in CKD patient AIM: This paper is aimed to review the effectiveness and safety at a supramaximal dose of 64 mg to a dose of 16 mg of candesartan. METHODS: We performed a literature search using PubMed, SCOPUS, EuropePMC, ProQuest, and Cochrane Central Databases using these keywords: “candesartan” and “16 mg” and “64 mg” or “proteinuria renal disease” or “albuminuria” and “blood pressure” that were published within the year of 1980–2021. Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) protocol were used to conduct this meta-analysis. We included randomized controlled trials, prospective cohort, retrospective or clinical observational evaluating the effect of candesartan in 16 mg or 64 mg in proteinuria renal disease patients regardless of clinical status. Non-randomized, controlled trials reporting efficacy were included if these trials were in the scope of our topic. Duplicate studies were excluded. Dichotomous variables were analyzed with the Mantel-Haenszel statistical method using risk ratio as the summary statistic and reported with 95% confidence intervals (CIs). RESULTS: Forty-six studies were initially generated using our search keyword. After applying inclusion and exclusion criteria, we included two studies in our analysis. Our pooled analysis found that candesartan 16mg dosage administration, compared to 64mg, was not associated with proteinuria reduction (std mean diff: −10.92 [95% CI: −40.09–18.26], p = 0.46). CONCLUSION: Candesartan supramaximal dosage 64 mg did not differ significantly in proteinuria reduction and blood pressure reduction against candesartan 16 mg. More studies are needed to determine this efficacy and safety.

Heart failure is promoted by the imbalance of sympathovagal, which increased sympathetic and decreased parasympathetic activity. BAT, an electrical stimulation technology, cause the baroreflex to be activated and balances the sympathovagal. Systematic review and meta-analysis were conducted, including published reports about the effectiveness of BAT in heart failure patients from PubMed, Embase, Cochrane, and Google Scholar to calculate the pooled standard mean difference and 95% confidence interval (95% CI) using either random or fixed effect model. Our search strategy identified 161 possible studies. Thirteen studies have been included as a full-text review. We excluded seven of these papers due to review, and our analysis has included six papers. Our combined analysis has shown that BAT is associated with an improvement in NYHA class compared to control (0.19[95%CI: 0.11-0.31], p = 0.000). Our pooled analysis also found that BAT, compared to control, was associated with 6-MHWD improvement, (-136.25[95%CI: -181.34 - -91.17], p = 0.000). Our pooled analysis also found that BAT, compared to control, was associated with HF hospitalization (-6.38[95%CI: -8.46 - -4.30], p = 0.000). BAT has a significant effect on improving NYHA Class, 6-minute hall walk distance, and decreasing HF patient's hospitalization days. Meanwhile, there is an insignificancy on LVEF and QoL improvement in HF patients. Future studies are still needed.

Heart failure is promoted by the imbalance of sympathovagal, which increased sympathetic and decreased parasympathetic activity. BAT, an electrical stimulation technology, cause the baroreflex to be activated and balances the sympathovagal. Systematic review and meta-analysis were conducted, including published reports about the effectiveness of BAT in heart failure patients from PubMed, Embase, Cochrane, and Google Scholar to calculate the pooled standard mean difference and 95% confidence interval (95% CI) using either random or fixed effect model. Our search strategy identified 161 possible studies. Thirteen studies have been included as a full-text review. We excluded seven of these papers due to review, and our analysis has included six papers. Our combined analysis has shown that BAT is associated with an improvement in NYHA class compared to control (0.19[95%CI: 0.11-0.31], p = 0.000). Our pooled analysis also found that BAT, compared to control, was associated with 6-MHWD improvement, (-136.25[95%CI: -181.34 - -91.17], p = 0.000). Our pooled analysis also found that BAT, compared to control, was associated with HF hospitalization (-6.38[95%CI: -8.46 - -4.30], p = 0.000). BAT has a significant effect on improving NYHA Class, 6-minute hall walk distance, and decreasing HF patient's hospitalization days. Meanwhile, there is an insignificancy on LVEF and QoL improvement in HF patients. Future studies are still needed.