Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have revolutionized the management of heart failure, diabetes, and chronic kidney disease. However, their use in daily clinical practice presents numerous challenges. This article explores practical issues associated with SGLT2i therapy from the perspectives of various specialists — including cardiologists, diabetologists, nephrologists, internists, gynecologists, urologists, and clinical pharmacologists. We discuss blood pressure control, dose adjustments of concomitant medications, the complexity of managing patients with heart failure with preserved ejection fraction or insulin resistance, and risks such as euglycemic ketoacidosis, genitourinary infections, and electrolyte disturbances. Special attention is given to emerging concerns like drug interactions, use in kidney transplant recipients, and implications in perioperative care. Additionally, we address gender-specific considerations and the potential use of SGLT2i in conditions such as polycystic ovary syndrome. This multidisciplinary review highlights both the therapeutic benefits and the clinical uncertainties surrounding SGLT2 inhibitors to support safe, rational, and individualized patient care in real-world clinical settings.
Background. This study aimed to examine the pharmacodynamic efficacy of the natural flavonoid com- pound luteolin diglucuronide (Lut) in preventing disturbances in baroreflex sensitivity (BRS) and reno- and cardiovascular hypertrophy in a one-kidney, one-clip (1K-1C) model of renovascular hypertension (RVH). Material and methods. Male Wistar rats, 3 months of age, were randomized into three groups: sham- -operated (SO) (n = 17); 1K-1C (subjected to renal artery clipping to induce renovascular hyperten- sion, n = 22); and 1K-1C treated with Lut (n = 23). Rats with RVH were treated with Lut 3 mg/kg/day for 2 weeks after the first week of surgical intervention. The pharmacological efficacy of Lut on mean arterial pressure (MAP), heart rate (HR), BRS, and cardiac and kidney remodeling was evaluated. ELISA kits were used to determine total epoxyeicosatrienoic acids (EETs), prostaglandin E2 (PGE2), proinflam- matory cytokines, blood urea nitrogen (BUN), and the plasma norepinephrine (NE)/epinephrine (EPN) ratio. Results. Preventive, long-term treatment with Lut [3 mg/kg intraperitoneally (i.p.) daily] in RVH rats significantly reduced MAP by 21% and increased the parasympathetic component of BRS by 34.4%, without marked alteration in the sympathetic component. Such deremodeling in BRS was associated with a significant decrease in heart and kidney hypertrophy and normalization of BUN in plasma. Prolonged treatment with Lut at small doses led to an increase in total EETs, which was coupled with reductions in interleukin 1beta (IL-1β), tumor necrosis factor alpha (TNF-α), and endothelin 1 (ET1) levels. Lut attenuated the elevation of norepinephrine and epinephrine levels in plasma. Conclusions. Thus, Lut provides a preventive, beneficial, pluripotent action in the “low-renin” model of RVH by exerting antihypertensive, cardio- and renoprotective effects and decreasing the development of “sterile inflammation”.
The presence of hypertensive left ventricular hypertrophy (LVH) is a risk feature associated with both cardiovascular morbidity and mortality. The aim of this review was to evaluate the available data about the diagnostic value of the cardiothoracic ratio (CTR) in the screening for LVH in patients with arterial hypertension. The PubMed and Science Direct databases were searched for terms associated with CTR, LVH, and hypertension. Only articles published in English and available in full text were considered. Finally, 13 papers were selected and analyzed. Hypertensive patients are characterized by increased CTR and left ventricular mass (LVM), when compared to controls. Importantly, mortality among hypertensive patients with a CTR ≥ 0.5 was higher than in those with a CTR < 0.5. In hypertensive patients CTR has varying sensitivities ranging from 16% to 53%, and specificities ranging from 86% to 88.3% for detection of LVH. A combination of CTR ≥ 0.5 with electrocardiographic (ECG) criteria and selected cardiovascular risk factors seems to be a better screening tool for LVH than solely ECG criteria. Thus, providing additional predictive information, especially CTR and clinical data in patients with hypertension, is valuable to improve the diagnostic value of ECG in LVH diagnosis.
Background: Generic drugs play a crucial role in improving access to pharmacotherapy and reducing healthcare costs. However, physicians' attitudes toward prescribing generics remain a key factor influencing their use in everyday clinical practice. This study aimed to assess physicians' attitudes toward generic drugs in Poland and to identify demographic and professional factors associated with prescribing preferences. Material and methods: A cross-sectional survey was conducted among 435 physicians in Poland using a structured questionnaire. The analysis focused on physicians' preferences when prescribing medications for long-term and shortterm therapies, their opinions on the safety and efficacy of generics, and their experiences with patient-reported outcomes related to both generic and original drugs. Statistical analyses included chi-square tests and non-parametric comparisons across subgroups by age, gender, speciality, and years of practice. Results: Half of the physicians (50.1%) reported no preference between original and generic drugs in long-term therapy, 25.2% preferred original drugs, 4.0% chose generics, and 20.6% indicated other responses. In short-term treatments, the proportion of physicians favouring original drugs remained higher (21.8%) than those choosing generics (4.3%). One in three physicians (35.2%) reported patient complaints of inefficacy or adverse events associated with generics, while similar issues were reported for original drugs (35.7%). Older, more experienced physicians were more likely to prefer original drugs and to express concerns about generics' safety and efficacy. Conclusions: Although many physicians in Poland perceive generic drugs as equivalent to original products, a significant proportion - particularly among older practitioners - express concerns regarding their clinical effectiveness, patient safety, and therapeutic outcomes. Educational initiatives and clearer clinical guidelines may this and enhance the rational use of
Background: The carotid intima-media thickness (CIMT) is considered a surrogate marker for arterial damage. Circadian blood pressure (BP) profile is perceived as a marker of cardiovascular health, where non-dipping status of BP in 24-hour monitoring (ABPM) seems to be correlated with detrimental factors such as overt adrenergic activity, obesity, aging, and diabetes mellitus. We aim to investigate the relationship between BP profiles, nighttime BP, and CIMT, particularly focusing on the dipper and non-dipper patterns identified through ABPM. Material and methods: Hypertensive patients without overt cardiovascular disease were recruited. In all subjects, 24-hr ABPM was performed, as well as a carotid ultrasound. CIMT was assessed offline semi-automatically. In all subjects, laboratory analysis, including blood glucose, lipid profile, creatinine, and uric acid, was performed. The related factors were evaluated by multivariable linear regression to find the independent factors. Results: A total of 206 patients (mean age 57.1 +/- 13.4 years, 57% females) were recruited. Multivariable linear regression revealed that age (p < 0.001), nighttime systolic blood pressure in ABPM (p < 0.006), and serum high-density lipoprotein (HDL) level (p = 0.03) were independently associated with CIMT. In contrast, dipping profile (p = 0.71), diabetes (p = 0.93), office systolic blood pressure (p = 0.06), and serum creatinine level (p = 0.95) were not independently associated with CIMT. Conclusions: Nocturnal BP is an independent risk factor for increased CIMT, more substantial than the relative day-night BP difference. In addition, low HDL cholesterol also plays a significant role as a risk factor for increased CIMT. Interpretation of ABPM and antihypertensive treatment should consider target nighttime BP values.
