Cardiovascular

Since the first description of a beta-blocking agent in 1962, this class of drug has become among the most widely used in the management of cardiovascular disease (CVD). Betablockers are now used routinely after a myocardial infarction, in patients with angina pectoris and as an additional therapy in the management of high blood pressure. However, they have traditionally been avoided in heart failure because it was thought that they were potentially harmful. But some large, well-designed randomised controlled trials have provided an overwhelming body of evidence to dispel this myth once and for all.

Editorial

Welcome to this issue of BJPCN. I find myself, rather like a modern-day Scrooge, worrying about how we will face the next financially challenging years in the NHS. The Government has recently announced a pay freeze for GPs, and Lawrence Buckman, chair of the BMA’s GP Committee, warns that this affects not just doctors but all of the members of the teams they work with. This will put pressure on primary care teams, which can spill into day-today interaction with each other and with patients. How can we ensure that the quality of patient care is maintained throughout these tough times?

New drugs and where they fit in the treatment algorithm

What can cardiac CT imaging add to our understanding in primary care?

The art of knowing when to take action and when to let well alone

Reply to Primary Care View on advances in cardiac tomography

Advances in cardiac computed tomography: an update for primary care physicians

When to use aspirin in the primary and secondary prevention of cardiovascular disease: acting on the latest evidence

Swollen ankles: preventing, detecting and managing oedema

It is Friday afternoon and, checking your screen, you see your last free appointment has been given to a patient you have seen in the past for routine blood tests. This time when she enters the room you observe that her legs are covered with what looks like kitchen roll, and she is wearing supermarket carrier bags over her feet to protect her shoes. For many of us, this is a ‘heart sink’ patient – with heavy, wet and oedematous legs that are difficult to manage. To be able to manage this type of condition we first need to understand the possible causes of oedema, to identify patients who may be at risk for developing the problem, and to be aware when early intervention could be of benefit.

What is the evidence for statins in the secondary prevention of stroke?

The Stroke Association estimates that about 150,000 people suffer a stroke in the UK each year. Stroke is the third commonest cause of death in developed countries and the leading cause of disability. So can we reduce this burden? In this article, we look at the evidence for statins in the secondary prevention of stroke.

Promoting research that optimises primary care management of CVD

How to estimate cardiovascular risk in practice

Beta-blockers in heart failure: are we doing the best we can for our patients?