Sex and Age Differences in Ambulatory Blood Pressure Monitoring Tolerability.

BACKGROUND: Clinical practice guidelines endorse using ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of hypertension. However, ABPM is not always tolerated by patients, and differences between individuals according to age and sex remain unexplored. METHODS: This is a post hoc analysis of a prospective, single-arm clinical trial (NCT03920956) that evaluated the feasibility of an ABPM service provided at 2 community pharmacies. Tolerability was assessed using a previously published survey, which included 7 yes/no questions and 8 answered on a scale of 0-10. Descriptive statistics and Chi-square analyses were used to summarize the data for the patient surveys and to describe sex and age differences in device tolerability. RESULTS: Of the 52 subjects enrolled, 50 (96%) completed the survey; half were female with a mean (SD) age of 57.5 years (15.8). Chi-square analyses showed that compared with their male counterparts, females were more likely to find the monitor cumbersome to wear (76.2% vs. 40%, P = 0.014). Subjects under 55 years of age were more likely to be disturbed by the noise of the monitor during driving (38.1% vs. 4.2%, P = 0.005) and at other times (35.0% vs. 8.3%, P = 0.029), and to find the monitor embarrassing to wear (33.3% vs. 7.1%, P = 0.019). CONCLUSIONS: Although ABPM was generally well-tolerated overall, we did identify age and sex differences in tolerability. These factors should be considered to ensure patient acceptance and tolerability of ABPM.

Effect of pharmacist interventions on reducing low-density lipoprotein cholesterol (LDL-C) levels: A systematic review and meta-analysis.

BACKGROUND: Clinical practice guidelines recommend team-based care as one strategy to improve dyslipidemia outcomes. Randomized controlled trials (RCTs) have demonstrated that pharmacist interventions reduce low-density lipoprotein cholesterol (LDL-C) levels. OBJECTIVE: The objective of the study was to conduct a meta-analysis to determine the effectiveness of pharmacist interventions on reducing LDL-C levels. METHODS: A literature search of RCTs published after January 1, 2000 was performed using MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Included RCTs evaluated a pharmacist intervention compared with usual care, reported baseline and follow-up LDL-C levels, and enrolled at least 100 patients. Mean differences in LDL-C and other lipid parameters were calculated using a random effects model. RESULTS: Twenty-six RCTs (n = 22,095 patients) were included in the meta-analysis. Compared with usual care, pharmacist interventions significantly reduced LDL-C levels by -7.9 mg/dL (95% confidence interval (CI) -11.43 to -4.35; I2 = 94%). A subgroup analysis revealed a greater reduction in LDL-C (-13.73 mg/dL; 95% CI -24.07 to -3.40; I2 = 96%) when LDL-C was the sole primary outcome. Significant improvements in total cholesterol (-12.73 mg/dL, 95% CI -19.18 to -6.27), triglycerides (-13.25 mg/dL, 95% CI -26.10 to -0.41), and high-density lipoprotein cholesterol (1.75 mg/dL, 95% CI 0.03 to 3.46) were also found. CONCLUSION: Pharmacist interventions significantly reduced LDL-C levels compared with usual care. Further research is warranted to determine the optimal pharmacist intervention for reducing LDL-C levels and to evaluate the comprehensive role of pharmacists in lipid management.

Cutting Edge: Differential Fine-Tuning of IL-2- and IL-15-Dependent Functions by Targeting Their Common IL-2/15Rß/γc Receptor.

Interleukin 2 and IL-15 are two closely related cytokines, displaying important functions in the immune system. They share the heterodimeric CD122/CD132 receptor to deliver their signals within target cells. Their specificity of action is conferred by their α receptor chains, IL-2Rα and IL-15Rα. By combining an increased affinity for CD122 and an impaired recruitment of CD132, we have generated an original molecule named IL-2Rß/γ (CD122/CD132) inhibitor (BiG), targeting the CD122/CD132 receptor. BiG efficiently inhibited IL-15- and IL-2-dependent functions of primary cells, including CD8 T and NK cells, in vitro and in vivo. We also report a differential dynamic of action of these cytokines by highlighting a major role played by the IL-2Rα receptor. Interestingly, due to the presence of IL-2Rα, BiG had no impact on IL-2-dependent regulatory T cell proliferation. Thus, by acting as a fine switch in the immune system, BiG emphasizes the differential roles of these two cytokines.