What is the explanation of a medical concept?

From the Guidelines

The concept of utility in medicine is evolving to prioritize patient-centered outcomes, including subjective symptoms, quality of life, and personal utility, in addition to traditional clinical outcomes such as morbidity and mortality. This shift is reflected in recent initiatives, such as the development of patient-reported outcome measure repositories and the emphasis on patient experience data by organizations like the National Institutes of Health and the Patient-Centered Outcomes Research Institute 1. The definition of utility in medicine is no longer solely focused on objective clinical features, but rather encompasses a broader set of outcomes that capture the perspectives of patients and their families.

Key aspects of utility in medicine include:

• Clinical utility, which refers to the ability of an intervention to impact medical management or downstream health outcomes 1
• Personal utility, which highlights the value of genetic and genomic testing for patients and their families, including alleviation of guilt, pragmatic life planning, and the ability to make informed decisions 1
• Patient-centered outcomes, which prioritize subjective symptoms, quality of life, and patient-reported experiences 1

The evidentiary threshold for adoption of new genomic medicine interventions is also being reevaluated, with some advocates arguing for a lower evidence threshold to demonstrate an impact on clinically relevant outcomes 1. The concept of actionability, which emphasizes the opportunity to take action based on genetic results, is being advanced as an alternative standard 1. Ultimately, the goal of utility in medicine is to improve patient outcomes, including morbidity, mortality, and quality of life, while also prioritizing patient-centered care and personal utility.

From the FDA Drug Label

Patients with a history of angioedema unrelated to ACE inhibitor therapy may be at increased risk of angioedema while receiving an ACE inhibitor Anaphylactoid Reactions During Desensitization: Two patients undergoing desensitizing treatment with hymenoptera venom while receiving ACE inhibitors sustained life threatening anaphylactoid reactions. Anaphylactoid Reactions During Membrane Exposure: Sudden and potentially life threatening anaphylactoid reactions have been reported in some patients dialyzed with high-flux membranes (e.g., AN69® 1) and treated concomitantly with an ACE inhibitor.

The ACE inhibitors can cause anaphylactoid reactions and angioedema in some patients.

• Anaphylactoid reactions have been reported in patients undergoing desensitization treatment with hymenoptera venom and in patients dialyzed with high-flux membranes.
• Patients with a history of angioedema unrelated to ACE inhibitor therapy may be at increased risk of angioedema while receiving an ACE inhibitor. 2

From the Research

Hypertension Treatment

• Hypertension is a disease and risk factor for cardiovascular disease (CVD), with each 20/10 mm Hg rise in blood pressure (BP) doubling the risk for CVD 3.
• The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) provides comprehensive guidelines on the diagnosis, classification, and management of hypertension and related CV conditions 3.

Antihypertensive Therapies

• The selection of antihypertensive therapies should be based on the presence of concomitant CV and metabolic conditions as well as patient-specific factors such as race 3.
• Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers may offer benefits beyond simple BP lowering, particularly in patients with comorbid CV or metabolic conditions 3, 4.
• Combining these established antihypertensive agents into a single pill continues to provide effective blood pressure lowering and improved cardiovascular outcomes while allowing a greater proportion of patients to rapidly achieve treatment targets 4.

Comparison of Antihypertensive Agents

• There is no evidence of a difference between ACE inhibitors and ARBs for total mortality, total cardiovascular events, or cardiovascular mortality 5.
• ARBs caused slightly fewer withdrawals due to adverse effects than ACE inhibitors, mainly attributable to a higher incidence of dry cough with ACE inhibitors 5.
• Diuretics and calcium-blocking drugs are more effective in elderly patients at lowering systolic blood pressure, while beta-blockers were relatively ineffective and had more side effects 6.
• ACE inhibitors and beta-blockers are equally effective in lowering BP and preventing cardiovascular events for patients whose BP is not controlled with a thiazide diuretic alone and who have no compelling indication for a specific 2nd-line agent 7.