BackgroundSodium‐glucose cotransporter 2 (SGLT2) inhibitors are a novel class of antihyperglycemic agents that improve glycemic control by increasing glycosuria. Additional benefits beyond glucose lowering include significant improvements in seated clinic blood pressure (BP), partly attributed to their diuretic‐like actions. Less known are the effects of this class on 24‐hour ambulatory BP, which is a better predictor of cardiovascular risk than seated clinic BP.Methods and ResultsWe performed a meta‐analysis of randomized, double‐blind, placebo‐controlled trials to investigate the effects of SGLT2 inhibitors on 24‐hour ambulatory BP. We searched all studies published before August 17, 2016, which reported 24‐hour ambulatory BP data. Mean differences in 24‐hour BP, daytime BP, and nighttime BP were calculated by a random‐effects model. SGLT2 inhibitors significantly reduce 24‐hour ambulatory systolic and diastolic BP by −3.76 mm Hg (95% CI, −4.23 to −2.34; I2=0.99) and −1.83 mm Hg (95% CI, −2.35 to −1.31; I2=0.76), respectively. Significant reductions in daytime and nighttime systolic and diastolic BP were also found. No association between baseline BP or change in body weight were observed.ConclusionsThis meta‐analysis shows that the reduction in 24‐hour ambulatory BP observed with SGLT2 inhibitors is a class effect. The diurnal effect of SGLT2 inhibitors on 24‐hour ambulatory BP may contribute to their favorable effects on cardiovascular outcomes.

Objective: To review glucose-lowering efficacy and changes in renal function associated with GLP-1 receptor agonists and SGLT2-Inhibitors among patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). Data Sources: A literature search of MEDLINE and Cochrane databases was performed from 2000 to March 2018 using search terms: SGLT2 inhibitors, sodium glucose co-transporter 2, canagliflozin, empagliflozin, dapagliflozin, glucagon-like peptide-1 receptor agonists, GLP-1, exenatide, liraglutide, albiglutide, dulaglutide, lixisenatide, semaglutide, and chronic kidney disease. References of identified articles were also reviewed. Study Selection and Data Extraction: English-language studies investigating glucose-lowering endpoints and/or changes in renal function with a U.S. approved SGLT2 inhibitor or GLP-1 receptor agonist were included. Data Synthesis: GLP-1 agonists and SGLT2-Inhibitors effectively lower glucose in patients with T2DM and CKD. Both agents have demonstrated short-term renoprotective effects by slowing progression of albuminuria and decreasing urine albumin-to-creatinine values. Relevance to Patient Care and Clinical Practice: This review highlights the glucose-lowering efficacy and reported renal benefits of GLP-1 agonists and SGLT2-Inhibitors when used in patients with T2DM and CKD. Given that these comorbidities are associated with increased cardiovascular risk, we believe that these agents should be the preferred add-on agents in most patients with uncontrolled T2DM and CKD. Conclusions: In patients with T2DM and CKD, GLP-1 agonists and SGLT2-Inhibitors are effective in lowering glucose, preventing progression of worsening albuminuria, and may reverse the

Use of reliable change scores to detect significant changes in performance on the SOT resulted in decreased sensitivity and improved specificity compared to a previous report. These findings indicate that some concussed athletes may not show large changes in postconcussion postural control and this postural control evaluation should not be used in exclusion of other assessment techniques. The postural control assessment should be combined with other evaluative measures to gain the highest sensitivity to concussive injuries.

Amiodarone remains the mostly frequently used antiarrhythmic in clinical practice and is most often used to maintain normal sinus rhythm in patients with atrial fibrillation who have failed a rate control strategy. Amiodarone has superior efficacy over other antiarrhythmics, a lower risk of torsade de pointes, and a better cardiovascular safety profile in patients with structural heart disease. However, amiodarone is associated with notable noncardiac toxicities affecting the thyroid, lungs, eyes, liver, and central nervous system. Since 2000, clinicians have been advised to follow amiodarone monitoring guidelines provided by the Heart Rhythm Society. Adherence to these recommendations in clinical practice, however, is suboptimal. Pharmacists play a major role in ensuring the safe and effective use of medications, particularly high-risk medications such as amiodarone. This qualitative review details the evidence supporting the role of pharmacist-led amiodarone monitoring services (AMS) in improving adherence to amiodarone monitoring guidelines and identifying adverse effects. Five studies were identified, and, overall, these programs had a favorable impact on improving adherence to guideline-recommended monitoring standards for amiodarone. The available evidence is limited by the significant variations in study designs and outcome definitions, lack of patient randomization, and limited generalizability. Nevertheless, available studies suggest that pharmacist-led AMS may improve adherence to recommended monitoring guidelines and identification of amiodarone-related adverse effects. Further study is warranted to demonstrate whether these services impact the overall quality of care provided to patients receiving amiodarone, which may justify broader implementation.

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