No abstract

Blood pressure (BP) readings in the doctor's office are mean awake ambulatory BP. Mean (± s.e.m.) routine office BP (mm Hg) recorded by the patient's physician frequently higher than home or ambulatory values. This study examines the role of the physician in the aetiology (155 ± 4/80 ± 2) was similar to the mean value obtained using the automated BP recording device of the 'white coat' effect, by comparing standard readings taken by the family physician of 27 treated hyper-(157 ± 3/83 ± 2). The mean awake ambulatory BP was 145 ± 3/78 ± 2 with the systolic value lower (P Ͻ Ͻ Ͻ 0.05) tensive patients with readings taken by an automated BP recording device, with the patient alone in the examthan either the physician or automated reading. Selfmeasurement of BP by the patient in the office setting ining room during the same office visit. The physician and automated readings were each compared to the does not reduce the magnitude of the white coat effect.Keywords: blood pressure; self measurement; white coat effect individuals already receiving antihypertensive ther- Introduction apy. Patients frequently exhibit an increase in bloodOne factor in the measurement of office BP has pressure (BP) when visiting their physician's office, not yet been examined in the clinical setting -does a phenomenon which has been called the 'white the presence of a physician in the examining room coat' effect. A variety of factors have been shown to affect the level of a patient's BP? The present study increase office BP compared to ambulatory readings addresses this question by comparing routine BP during usual daily activities. BP increases upon the readings taken by the patient's family physician arrival of the patient in the doctor's office and tends using a mercury sphygmomanometer with readings to diminish during the subsequent 10 min. 1 Convertaken by an automated BP recording device with the sation with the patient also tends to accentuate the patient resting alone in the examination room. Both white coat effect. 2 Office BP and the consequent the automated and physician readings were also white coat effect may be reduced by having a nurse compared to the ambulatory BP to see if the use of record the office BP. 1,3 Digit preference, the use of an automated device could reduce any white coat aneuroid sphygmomanometers and unfamiliar sureffect which might be present. roundings for new patients may also contribute to higher office readings and the misdiagnosis of Patients and methodshypertension. 4 The white coat effect has usually been considered Patient population as part of the diagnosis of patients with possiblePatients were recruited from the computerised rechypertension. In previous studies 5,6 we have also ords of a family practice unit in a university teachnoted a persistent difference between office and ing hospital (Sunnybrook Health Science Center). A ambulatory readings in patients receiving long-term random sample of 45 treated hypertensive patients antihypertensive therapy from their own family were identified. Initi...

Purpose of review Following coronary artery bypass grafting (CABG), there remains persistent risk of ischemic events despite secondary prevention strategies, including low-density lipoprotein cholesterol lowering. Although REDUCE-IT recently demonstrated the benefits of icosapent ethyl (IPE) on reducing ischemic events in a broad population of primary and secondary prevention patients, its generalizability to a contemporary CABG population is not known. This article aims to ascertain the proportion of patients with a history of CABG that would be eligible for IPE treatment. Recent findings A review of recent literature highlights the presence of residual ischemic following CABG. Using the Québec Heart Database, a repository of contemporary Canadian cardiac patient information, was searched between 1 January 2006 and 31 December 2016, to ascertain generalizability of IPE. Summary In a large (N = 12 641), contemporary, Canadian cohort of patients with a history of CABG and currently on statin therapy, 21.9, 33.6 and 26.4% would be eligible for IPE, according to REDUCE-IT, Health Canada, and Food and Drug Administration criteria, respectively. These analyses would support IPE as an adjunct to secondary prevention therapies post-CABG.

Purpose of review The management of individuals who live with type 2 diabetes requires an integrated and multifaceted approach. Recent findings Sodium–glucose cotransporter 2 inhibitors effectively prevent and treat cardiorenal complications in the presence of type 2 diabetes. They also reduce death and disease progression in those with established heart failure (with reduced ejection fraction) in the absence of diabetes. Summary Close collaborations between primary care physicians, cardiovascular specialists, endocrinologists and nephrologists are necessary to optimize cardiovascular, renal and metabolic risk reduction in their shared patients.