Volume 8, Issue 5

Background. Hypertensive heart disease (HHD) is a common and preventable consequence of long-standing hypertension, yet comparative data from Southeast Asia remain scarce. This study compared the determinants, clinical patterns, and treatment of HHD at two tertiary centers in Indonesia and Malaysia. Methods. We conducted a retrospective cross-sectional comparative study of 600 adults with HHD (300 per site) managed at tertiary hospitals in Makassar, Indonesia, and Kuala Terengganu, Malaysia, between January 2022 and December 2023. Demographic, clinical, echocardiographic, and prescribing data were extracted from medical records, and determinants of left ventricular hypertrophy (LVH) were assessed with multivariable logistic regression. Results. Mean age was 58.4 ± 10.7 years and 52.3% of patients were male. LVH was present in 72.0%, diastolic dysfunction in 48.7%, and heart failure with preserved ejection fraction (HFpEF) in 28.5%. Diabetes mellitus (36.8%) and dyslipidemia (41.2%) were more frequent in Makassar and were independent determinants of LVH (p < 0.05). Use of renin–angiotensin system (RAS) inhibitors was higher in Kuala Terengganu than in Makassar (68.7% vs 52.3%, p < 0.001), whereas calcium channel blockers were prescribed more often in Makassar. Conclusions. HHD at both sites carried a high burden of LVH and diastolic dysfunction, with diabetes and dyslipidemia as key modifiable determinants. The lower use of RAS inhibitors in Makassar indicates a treatment gap that could be narrowed through better formulary access and guideline-based prescribing.

Background. Point-of-care (POC) HbA1c testing makes results available during the consultation and may support timely treatment decisions in type 2 diabetes, but its effect on glycemic control in primary care remains uncertain. Methods. We searched MEDLINE, Embase, CINAHL, the Cochrane Central Register of Controlled Trials, and Web of Science from inception to January 31, 2026, for randomized and nonrandomized controlled studies comparing POC with laboratory HbA1c testing in adults with type 2 diabetes managed in primary care. Two reviewers independently screened records, extracted data, and assessed risk of bias. Mean differences (MD) in HbA1c were pooled by random-effects meta-analysis, and certainty of evidence was rated with GRADE. Results. Fourteen studies (8 randomized trials and 6 nonrandomized studies; 5,872 participants) were included, and 12 (4,918 participants) contributed to the meta-analysis. POC testing was associated with a greater reduction in HbA1c (MD −0.26 percentage points, 95% CI −0.38 to −0.14; I² = 61%). The effect was smaller in randomized trials (MD −0.21, 95% CI −0.34 to −0.08) and larger when baseline HbA1c was 8.0% or higher (MD −0.41, 95% CI −0.60 to −0.22). POC testing increased the proportion of patients reaching an HbA1c below 7.0% (risk ratio 1.18, 95% CI 1.06–1.31) and treatment intensification at the index visit (risk ratio 1.34, 95% CI 1.12–1.60). Conclusions. Moderate-certainty evidence indicates that POC HbA1c testing in primary care produces a modest improvement in glycemic control, largely through more timely treatment intensification, with the greatest benefit in patients with poorly controlled diabetes.

Background. Population aging in Brazil has been accompanied by growing multimorbidity and medication use, but population-based data on potentially inappropriate medications (PIMs) among community-dwelling older adults remain limited. Methods. We conducted a population-based cross-sectional household survey of adults aged 60 years or older in Belo Horizonte, Brazil, between March and November 2024. All medicines used in the previous 15 days were recorded through a structured interview and inspection of medicine packages. PIMs were identified with the 2023 American Geriatrics Society Beers Criteria and the Brazilian consensus on PIMs, and polypharmacy was defined as the use of five or more medicines. Factors associated with PIM use were examined with Poisson regression with robust variance. Results. Among 1,212 participants (mean age 71.6 ± 7.9 years; 62.4% women), 39.8% met the definition of polypharmacy and 6.1% used ten or more medicines. Overall, 45.3% used at least one PIM, most often long-term proton pump inhibitors (14.2%), benzodiazepines (9.6%), and glibenclamide (7.4%). PIM use was independently associated with polypharmacy (prevalence ratio 2.03, 95% CI 1.78–2.31), female sex (1.21, 95% CI 1.07–1.37), fair or poor self-rated health (1.18, 95% CI 1.04–1.34), and consultation with three or more physicians in the previous year (1.16, 95% CI 1.02–1.32). Conclusions. Nearly half of community-dwelling older adults in Belo Horizonte used at least one PIM, mostly drugs for which safer alternatives exist. Structured medication review in primary care and revision of public formularies, particularly for proton pump inhibitors, benzodiazepines, and glibenclamide, could reduce avoidable medication-related harm.

Introduction. Takotsubo syndrome (TTS) is an acute, usually reversible form of left ventricular dysfunction that is often triggered by emotional or physical stress. Exogenous catecholamines and beta-adrenergic agonists are recognized but uncommon triggers, and the syndrome is easily overlooked in acute asthma, where tachycardia and chest discomfort are readily attributed to the exacerbation itself. Case presentation. A 46-year-old woman with long-standing asthma presented with a severe exacerbation and hypercapnia. She received continuous nebulized albuterol (approximately 105 mg over 12 hours), ipratropium, intravenous methylprednisolone and magnesium sulfate, and two doses of subcutaneous terbutaline. Ten hours after admission she developed new retrosternal pressure and hypotension, with anterior ST-segment elevation and a rise in high-sensitivity troponin I from 9 to 1,840 ng/L. Echocardiography showed apical ballooning with a left ventricular ejection fraction of 35%, and coronary angiography revealed no obstructive disease. Cardiac magnetic resonance imaging showed apical myocardial edema without late gadolinium enhancement. Beta-agonists were withdrawn and the exacerbation was managed with an inhaled anticholinergic and systemic corticosteroids. Ventricular function recovered fully within 6 weeks, with an ejection fraction of 60%. Conclusion. High-dose beta-agonist therapy for acute asthma can precipitate TTS. New chest pain, hypotension, or electrocardiographic changes during intensive bronchodilator treatment warrant prompt cardiac evaluation, and cumulative beta-agonist exposure should be limited once the diagnosis is suspected.