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NSAIDs with increasing degrees of relative cyclooxygenase-2 selectivity should not be administered to patients with NSTE-ACS and chronic musculoskeletal discomfort when therapy with acetaminophen, nonacetylated salicylates, tramadol, small doses of narcotics, or nonselective NSAIDs provide acceptable pain relief.
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Eight centers participated in the study, which was approved by the institutional review board at each site.
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As a larger body of evidence becomes available, recommendations and their grading levels are updated.
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In the placebo-controlled factorial design study, the population treated with a telmisartan and amlodipine combination had a mean age of 53 years and included approximately 50% males, 79% were Caucasian, 17% Blacks, and 4% Asians.
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The study gave a clear result: telmisartan provided equivalent efficacy to ramipril but with fewer discontinuations, whereas the combination was no more effective but was associated with worse tolerability.
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We would also determine whether the combination of the two drugs was more effective than ramipril alone in reducing the composite outcome of death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure.
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Given the substantially increased risk of hypoglycemia (particularly in those with type 1 diabetes, but also in the recent type 2 diabetes trials), the concerning mortality findings in the ACCORD trial (), and the relatively much greater effort required to achieve near-normoglycemia, the risks of lower glycemic targets may outweigh the potential benefits on microvascular complications on a population level.
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