Old Questions, New Options: Spironolactone for Resistant Hypertension and Polymer-Free Stents

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This week, we debut our new “Two Truths, One Lie” segment! Join us and put your knowledge to the test.

As always, Amol, general internal medicine resident at the University of Toronto, and Reena, staff physician at St. Michael’s hospital, discuss 2 recent papers:

A multi-centred cross over trial conducted in the UK tried to answer the question: for patients with resistant hypertension despite being on triple therapy, what should be added as a fourth agent? The study found that spironolactone is superior to bisoprolol, doxazosin, or placebo. Reena and Amol are both believers in this trial and plan to change their practice – will you?

A new stent option for patients with atherosclerotic disease and high bleeding risk? A double blinded randomized control trial found that a new generation of polymer-free, drug-coated coronary stents is superior to bare metal stents in safety and efficacy. Amol asks, how do these new polymer-free stents compare to drug eluting stents that have a polymer coating? Is such a study in the works? If you know the answer, let us know on Twitter @roundstable!

The Papers

1. Resistant hypertension: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00257-3/abstract

2. New stent: http://www.nejm.org/doi/full/10.1056/NEJMoa1503943

Good Stuff

1. Measuring doctors & teachers: http://www.nytimes.com/2016/01/17/opinion/sunday/how-measurement-fails-doctors-and-teachers.html?_r=0

2. Andexanet as anticoagulant reversal agent: http://www.nejm.org/doi/full/10.1056/NEJMoa1510991

3. Cardiac arrest & highrises: http://www.thestar.com/life/health_wellness/2016/01/18/heart-attacks-in-highrises-a-deadly-combination-toronto-study-shows.html

Two Truths, One Lie

1. http://guidelines.diabetes.ca/CDACPG/media/documents/patient-resources/heart-disease-and-stroke-2014.pdf

2. https://nei.nih.gov/health/diabetic/retinopathy

3. https://www.cna-aiic.ca/~/media/cna/files/en/fact_sheet_18_e.pdf?la=en

Music Credits (Creative Commons)

In your Robotic Heart – Nicolai Heidlas https://soundcloud.com/nicolai-heidlas/in-your-robotic-heart

Drive – Nicolai Heidlas https://soundcloud.com/nicolai-heidlas/drive-fresh-upbeat-pop-background-music

Vintage Dream – Nicolai Heidlas https://soundcloud.com/nicolai-heidlas/vintage-dream-loungejazzy-background-music

All tracks have been modified for the purposes of this podcast.

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