Maan A. Fares, MD

In cardiovascular medicine, advances in our understanding of disease processes, medical management, and interventional and surgical techniques have gone a long way toward improving the health of patients. But we face challenges and opportunities in how best to apply these discoveries to improve the quality of care we provide and do so without driving up costs or wasting resources.

This Cleveland Clinic Journal of Medicine supplement on cardiovascular disease aims to illuminate some of the challenges and advances in the management of cardiac amyloidosis, coronary artery chronic total occlusion, venous thromboembolism, implantable device infection, and lung transplant. In so doing, my colleagues present insights into which advances will benefit which patients to improve quality and contain cost.

Cardiac amyloidosis, sometimes called stiff heart syndrome, is the most common restrictive cardiomyopathy. Amyloid deposits in the heart muscle can affect conduction of electrical signals leading to arrhythmias and heart block. Joseph P. Donnelly, MD, and Mazen Hanna, MD, present a comprehensive review of cardiac amyloidosis and share exciting advances in the detection and treatment of this condition and clues to identify patients who may be affected by this often overlooked condition.

Also in this supplement, Jaikirshan Khatri, MD, and colleagues review the use of percutaneous coronary intervention (PCI) for patients with coronary artery chronic total occlusion (CTO). Though CTO is often considered benign, the affected myocardium is ischemic and patients with significant ischemic burden may benefit clinically from CTO PCI. A technically demanding procedure, CTO PCI success rates are highly operator-dependent.

John R. Bartholomew, MD, presents information about the management of venous thromboembolism (VTE) including recent changes to treatment guidelines. Patients with VTE require immediate treatment with anticoagulation therapy. Recent changes to treatment guidelines now recommend direct oral anticoagulants for patients with VTE and no cancer. Direct oral anticoagulants are an important new option for patients and further study would be beneficial to strengthen the level of evidence regarding which anticoagulation therapy is best for which patients.

Cardiac implantable electronic devices (CIEDs) improve quality of life and longevity for increasing numbers of patients with cardiac disease. Cameron T. Lambert, MD, and Khaldoun G. Tarakji, MD, MPH, discuss the types of CIED infections that occur in about 1% of patients receiving a first CIED. Prompt diagnosis improves the success of antibiotic therapy, device removal, and resolution of the infection.

Finally, Kenneth R. McCurry, MD, and Marie M. Budev, DO, MPH, discuss lung transplant for patients with end-stage lung disease. Lung transplant may be an option to extend survival and improve the quality of life for some patients. In this article, the authors review the selection criteria for lung transplant candidates, including when physicians should refer patients to lung transplant centers for evaluation and placement on the lung transplant waiting list.

We hope this supplement is a useful review of some of the challenges and advances in cardiovascular medicine and is beneficial to you and your clinical practice.

In cardiovascular medicine, advances in our understanding of disease processes, medical management, and interventional and surgical techniques have gone a long way toward improving the health of patients. But we face challenges and opportunities in how best to apply these discoveries to improve the quality of care we provide and do so without driving up costs or wasting resources.

This Cleveland Clinic Journal of Medicine supplement on cardiovascular disease aims to illuminate some of the challenges and advances in the management of cardiac amyloidosis, coronary artery chronic total occlusion, venous thromboembolism, implantable device infection, and lung transplant. In so doing, my colleagues present insights into which advances will benefit which patients to improve quality and contain cost.

Cardiac amyloidosis, sometimes called stiff heart syndrome, is the most common restrictive cardiomyopathy. Amyloid deposits in the heart muscle can affect conduction of electrical signals leading to arrhythmias and heart block. Joseph P. Donnelly, MD, and Mazen Hanna, MD, present a comprehensive review of cardiac amyloidosis and share exciting advances in the detection and treatment of this condition and clues to identify patients who may be affected by this often overlooked condition.

Also in this supplement, Jaikirshan Khatri, MD, and colleagues review the use of percutaneous coronary intervention (PCI) for patients with coronary artery chronic total occlusion (CTO). Though CTO is often considered benign, the affected myocardium is ischemic and patients with significant ischemic burden may benefit clinically from CTO PCI. A technically demanding procedure, CTO PCI success rates are highly operator-dependent.

John R. Bartholomew, MD, presents information about the management of venous thromboembolism (VTE) including recent changes to treatment guidelines. Patients with VTE require immediate treatment with anticoagulation therapy. Recent changes to treatment guidelines now recommend direct oral anticoagulants for patients with VTE and no cancer. Direct oral anticoagulants are an important new option for patients and further study would be beneficial to strengthen the level of evidence regarding which anticoagulation therapy is best for which patients.

Cardiac implantable electronic devices (CIEDs) improve quality of life and longevity for increasing numbers of patients with cardiac disease. Cameron T. Lambert, MD, and Khaldoun G. Tarakji, MD, MPH, discuss the types of CIED infections that occur in about 1% of patients receiving a first CIED. Prompt diagnosis improves the success of antibiotic therapy, device removal, and resolution of the infection.

Finally, Kenneth R. McCurry, MD, and Marie M. Budev, DO, MPH, discuss lung transplant for patients with end-stage lung disease. Lung transplant may be an option to extend survival and improve the quality of life for some patients. In this article, the authors review the selection criteria for lung transplant candidates, including when physicians should refer patients to lung transplant centers for evaluation and placement on the lung transplant waiting list.

We hope this supplement is a useful review of some of the challenges and advances in cardiovascular medicine and is beneficial to you and your clinical practice.

In cardiovascular medicine, advances in our understanding of disease processes, medical management, and interventional and surgical techniques have gone a long way toward improving the health of patients. But we face challenges and opportunities in how best to apply these discoveries to improve the quality of care we provide and do so without driving up costs or wasting resources.

This Cleveland Clinic Journal of Medicine supplement on cardiovascular disease aims to illuminate some of the challenges and advances in the management of cardiac amyloidosis, coronary artery chronic total occlusion, venous thromboembolism, implantable device infection, and lung transplant. In so doing, my colleagues present insights into which advances will benefit which patients to improve quality and contain cost.

Cardiac amyloidosis, sometimes called stiff heart syndrome, is the most common restrictive cardiomyopathy. Amyloid deposits in the heart muscle can affect conduction of electrical signals leading to arrhythmias and heart block. Joseph P. Donnelly, MD, and Mazen Hanna, MD, present a comprehensive review of cardiac amyloidosis and share exciting advances in the detection and treatment of this condition and clues to identify patients who may be affected by this often overlooked condition.

Also in this supplement, Jaikirshan Khatri, MD, and colleagues review the use of percutaneous coronary intervention (PCI) for patients with coronary artery chronic total occlusion (CTO). Though CTO is often considered benign, the affected myocardium is ischemic and patients with significant ischemic burden may benefit clinically from CTO PCI. A technically demanding procedure, CTO PCI success rates are highly operator-dependent.

John R. Bartholomew, MD, presents information about the management of venous thromboembolism (VTE) including recent changes to treatment guidelines. Patients with VTE require immediate treatment with anticoagulation therapy. Recent changes to treatment guidelines now recommend direct oral anticoagulants for patients with VTE and no cancer. Direct oral anticoagulants are an important new option for patients and further study would be beneficial to strengthen the level of evidence regarding which anticoagulation therapy is best for which patients.

Cardiac implantable electronic devices (CIEDs) improve quality of life and longevity for increasing numbers of patients with cardiac disease. Cameron T. Lambert, MD, and Khaldoun G. Tarakji, MD, MPH, discuss the types of CIED infections that occur in about 1% of patients receiving a first CIED. Prompt diagnosis improves the success of antibiotic therapy, device removal, and resolution of the infection.

Finally, Kenneth R. McCurry, MD, and Marie M. Budev, DO, MPH, discuss lung transplant for patients with end-stage lung disease. Lung transplant may be an option to extend survival and improve the quality of life for some patients. In this article, the authors review the selection criteria for lung transplant candidates, including when physicians should refer patients to lung transplant centers for evaluation and placement on the lung transplant waiting list.

We hope this supplement is a useful review of some of the challenges and advances in cardiovascular medicine and is beneficial to you and your clinical practice.

Innovations are dominating the early part of the 21st century and the impact on cardiovascular medicine has been especially remarkable. Keeping up and evaluating the relevance of these innovations and the role in patient care is a constant challenge and opportunity for providers and scientists alike.

This Cleveland Clinic Journal of Medicine supplement on cardiovascular disease presents healthcare providers with evidenced-based reviews of important innovations and a glimpse into their potential for an exciting future.

In this supplement, Amar Krishnaswamy, MD, and colleagues look to new frontiers in valve replacement therapies. The success of transcatheter aortic valve replacement has led to extending the technique to the mitral valve. While technical challenges exist with transcatheter mitral valve replacement, methods to overcome these challenges are feasible. The authors review the various valve devices currently under development and examine their potential implications in practice.

The introduction of stents in percutaneous coronary interventions has been one of the most revolutionary innovations in cardiovascular medicine, resulting in impressive outcomes during the past few decades. Despite the dramatic advancement, persistent rates of restenosis and thrombosis continue to cause substantial morbidity and mortality. Stephen Ellis, MD, and Haris Riaz, MD, discuss the evolution of stent design from bare-metal stents through drug-eluting stents and their impact on outcomes. The evolution continues with the development of bioresorbable polymers and stents without polymers. The authors consider the promise of these innovations, especially bioresorbable stents, to further reduce restenosis and stent thrombosis.

Erich Kiehl, MD, and Daniel Cantillon, MD, present information about the latest innovation in cardiac pacing—leadless pacemakers. The first leadless pacemaker was approved earlier this year. In over 50 years of use of transvenous pacemakers, long-term complications have primarily involved the endovascular leads and surgical pocket. The authors discuss the promise of leadless cardiac pacing using catheter-based delivery of a self-contained device in the right ventricle to favorably reduce these complications, as well the current limitation of single-chamber pacing and possible future directions.

Innovations in monoclonal antibody therapy have resulted in a new class of biologic drugs to lower low-density-lipoprotein (LDL) in the blood—PCSK9 inhibitors. These new biologics target the overexpression of the PCSK9 protein in the liver, thereby increasing LDL receptors available to metabolize and remove LDL from the blood. Khendi White, MD, Chaitra Mohan, MD, and Michael Rocco, MD, discuss potential candidates for recently approved PCSK9 inhibitor therapy.

Ellen Brinza, MS, and Heather Gornik, MD, discuss new findings in our understanding of fibromuscular dysplasia (FMD). This uncommon nonatherosclerotic disease leads to narrowing, dissection, or aneurysm of medium-sized arteries. FMD is caused by abnormal development of the arterial cell wall and can cause symptoms if narrowing or a tear decreases blood flow through the artery. The authors discuss evaluation, management, and surveillance strategies as well as important lifestyle modifications and appropriate treatment of symptoms.

We hope this presentation of recent innovations in cardiovascular medicine is useful and informative to you and your clinical practice.

Innovations are dominating the early part of the 21st century and the impact on cardiovascular medicine has been especially remarkable. Keeping up and evaluating the relevance of these innovations and the role in patient care is a constant challenge and opportunity for providers and scientists alike.

This Cleveland Clinic Journal of Medicine supplement on cardiovascular disease presents healthcare providers with evidenced-based reviews of important innovations and a glimpse into their potential for an exciting future.

In this supplement, Amar Krishnaswamy, MD, and colleagues look to new frontiers in valve replacement therapies. The success of transcatheter aortic valve replacement has led to extending the technique to the mitral valve. While technical challenges exist with transcatheter mitral valve replacement, methods to overcome these challenges are feasible. The authors review the various valve devices currently under development and examine their potential implications in practice.

The introduction of stents in percutaneous coronary interventions has been one of the most revolutionary innovations in cardiovascular medicine, resulting in impressive outcomes during the past few decades. Despite the dramatic advancement, persistent rates of restenosis and thrombosis continue to cause substantial morbidity and mortality. Stephen Ellis, MD, and Haris Riaz, MD, discuss the evolution of stent design from bare-metal stents through drug-eluting stents and their impact on outcomes. The evolution continues with the development of bioresorbable polymers and stents without polymers. The authors consider the promise of these innovations, especially bioresorbable stents, to further reduce restenosis and stent thrombosis.

Erich Kiehl, MD, and Daniel Cantillon, MD, present information about the latest innovation in cardiac pacing—leadless pacemakers. The first leadless pacemaker was approved earlier this year. In over 50 years of use of transvenous pacemakers, long-term complications have primarily involved the endovascular leads and surgical pocket. The authors discuss the promise of leadless cardiac pacing using catheter-based delivery of a self-contained device in the right ventricle to favorably reduce these complications, as well the current limitation of single-chamber pacing and possible future directions.

Innovations in monoclonal antibody therapy have resulted in a new class of biologic drugs to lower low-density-lipoprotein (LDL) in the blood—PCSK9 inhibitors. These new biologics target the overexpression of the PCSK9 protein in the liver, thereby increasing LDL receptors available to metabolize and remove LDL from the blood. Khendi White, MD, Chaitra Mohan, MD, and Michael Rocco, MD, discuss potential candidates for recently approved PCSK9 inhibitor therapy.

Ellen Brinza, MS, and Heather Gornik, MD, discuss new findings in our understanding of fibromuscular dysplasia (FMD). This uncommon nonatherosclerotic disease leads to narrowing, dissection, or aneurysm of medium-sized arteries. FMD is caused by abnormal development of the arterial cell wall and can cause symptoms if narrowing or a tear decreases blood flow through the artery. The authors discuss evaluation, management, and surveillance strategies as well as important lifestyle modifications and appropriate treatment of symptoms.

We hope this presentation of recent innovations in cardiovascular medicine is useful and informative to you and your clinical practice.

Innovations are dominating the early part of the 21st century and the impact on cardiovascular medicine has been especially remarkable. Keeping up and evaluating the relevance of these innovations and the role in patient care is a constant challenge and opportunity for providers and scientists alike.

This Cleveland Clinic Journal of Medicine supplement on cardiovascular disease presents healthcare providers with evidenced-based reviews of important innovations and a glimpse into their potential for an exciting future.

In this supplement, Amar Krishnaswamy, MD, and colleagues look to new frontiers in valve replacement therapies. The success of transcatheter aortic valve replacement has led to extending the technique to the mitral valve. While technical challenges exist with transcatheter mitral valve replacement, methods to overcome these challenges are feasible. The authors review the various valve devices currently under development and examine their potential implications in practice.

The introduction of stents in percutaneous coronary interventions has been one of the most revolutionary innovations in cardiovascular medicine, resulting in impressive outcomes during the past few decades. Despite the dramatic advancement, persistent rates of restenosis and thrombosis continue to cause substantial morbidity and mortality. Stephen Ellis, MD, and Haris Riaz, MD, discuss the evolution of stent design from bare-metal stents through drug-eluting stents and their impact on outcomes. The evolution continues with the development of bioresorbable polymers and stents without polymers. The authors consider the promise of these innovations, especially bioresorbable stents, to further reduce restenosis and stent thrombosis.

Erich Kiehl, MD, and Daniel Cantillon, MD, present information about the latest innovation in cardiac pacing—leadless pacemakers. The first leadless pacemaker was approved earlier this year. In over 50 years of use of transvenous pacemakers, long-term complications have primarily involved the endovascular leads and surgical pocket. The authors discuss the promise of leadless cardiac pacing using catheter-based delivery of a self-contained device in the right ventricle to favorably reduce these complications, as well the current limitation of single-chamber pacing and possible future directions.

Innovations in monoclonal antibody therapy have resulted in a new class of biologic drugs to lower low-density-lipoprotein (LDL) in the blood—PCSK9 inhibitors. These new biologics target the overexpression of the PCSK9 protein in the liver, thereby increasing LDL receptors available to metabolize and remove LDL from the blood. Khendi White, MD, Chaitra Mohan, MD, and Michael Rocco, MD, discuss potential candidates for recently approved PCSK9 inhibitor therapy.

Ellen Brinza, MS, and Heather Gornik, MD, discuss new findings in our understanding of fibromuscular dysplasia (FMD). This uncommon nonatherosclerotic disease leads to narrowing, dissection, or aneurysm of medium-sized arteries. FMD is caused by abnormal development of the arterial cell wall and can cause symptoms if narrowing or a tear decreases blood flow through the artery. The authors discuss evaluation, management, and surveillance strategies as well as important lifestyle modifications and appropriate treatment of symptoms.

We hope this presentation of recent innovations in cardiovascular medicine is useful and informative to you and your clinical practice.

Physicians who were educated and began practicing in the 20th century have witnessed some of the most significant innovations and discoveries in the history of healthcare. While major surgical and therapeutic milestones defined the previous century, our current century is defined by the high-speed pace of technological innovations that affect the practice of medicine. For example, the proliferation of hand-held communication devices now provides immediate access to a wealth of healthcare information. Ultimately, recollecting information will be less necessary and far less valuable than understanding the concepts behind it. The challenge for providers is to recognize how to incorporate these innovations into the traditional model of treating diseases with the goal of improving outcomes and containing costs.

With that objective in mind, the articles in this Cleveland Clinic Journal of Medicine supplement on cardiovascular disease aim to not only review traditional treatment models for cardiovascular disease but, more importantly, to address the broad implications of new innovations on day-to-day clinical practice.

Stephanie Mick, MD, and colleagues look at how the emergence of new devices and technologies has dramatically improved the treatment of severe aortic valve stenosis and expanded the patient population eligible for aortic valve replacement. The authors review the expanded array of surgical approaches to transcatheter aortic valve replacement and the development of new devices in light of their impact on reducing the risks and improving the outcomes associated with this therapy.

Oussama Wazni, MD, and colleagues present evidence underlying the evolving strategies to prevent serious complications of stroke and thromboembolism in patients with atrial fibrillation. Newer anticoagulants are changing the strategic picture. The article includes discussion of the safety and efficacy of the available anticoagulants, as well as nonpharmacologic approaches, and considers how the new data and medications affect traditional treatment models. The authors integrate the data into an evidence-based appraisal of how to best use these innovations to reduce stroke risk in this patient population.

Acute strokes have a significant impact on morbidity and mortality worldwide. Findings that stress the importance of reducing the “time to treatment”—the shorter the time, the better the outcomes—have pushed treatment approaches to center stage. A key factor is the time it takes for patients to arrive in the emergency department. One way to reduce this time is to take the treatment to the patient. Peter A. Rasmussen, MD, looks at how innovations in scanning technologies and wireless data transmissions have led to the development of spe- cially equipped mobile stroke units that can accurately differentiate the types of stroke and enable practitioners to more quickly begin appropriate thromboembolic therapy and reduce the time to therapy.

Barbara Heil, MD, and W. H. Wilson Tang, MD, review the use of cardiac biomarkers to diagnose and treat heart failure. Studies have shown the efficacy of using biomarkers to identify high-risk patients, but various factors limit their diagnostic accuracy and clinical adaptability. The authors summarize the data and explain how to incorporate biomarkers into clinical practice.

Hypertension control remains an elusive goal for practitioners. Joel Handler, MD, reviews how new evidence and innovations are revising the diagnostic guidelines and the recommended treatment strategies. He discusses innovations associated with out-of-office monitoring and new data from clinical trials that are changing the clinical practice model. He also addresses the controversy regarding systolic blood pressure goals in elderly patients and how these data have affected evidence-based guidelines.

We hope you find this supplement both informative and thought-provoking.

Physicians who were educated and began practicing in the 20th century have witnessed some of the most significant innovations and discoveries in the history of healthcare. While major surgical and therapeutic milestones defined the previous century, our current century is defined by the high-speed pace of technological innovations that affect the practice of medicine. For example, the proliferation of hand-held communication devices now provides immediate access to a wealth of healthcare information. Ultimately, recollecting information will be less necessary and far less valuable than understanding the concepts behind it. The challenge for providers is to recognize how to incorporate these innovations into the traditional model of treating diseases with the goal of improving outcomes and containing costs.

With that objective in mind, the articles in this Cleveland Clinic Journal of Medicine supplement on cardiovascular disease aim to not only review traditional treatment models for cardiovascular disease but, more importantly, to address the broad implications of new innovations on day-to-day clinical practice.

Stephanie Mick, MD, and colleagues look at how the emergence of new devices and technologies has dramatically improved the treatment of severe aortic valve stenosis and expanded the patient population eligible for aortic valve replacement. The authors review the expanded array of surgical approaches to transcatheter aortic valve replacement and the development of new devices in light of their impact on reducing the risks and improving the outcomes associated with this therapy.

Oussama Wazni, MD, and colleagues present evidence underlying the evolving strategies to prevent serious complications of stroke and thromboembolism in patients with atrial fibrillation. Newer anticoagulants are changing the strategic picture. The article includes discussion of the safety and efficacy of the available anticoagulants, as well as nonpharmacologic approaches, and considers how the new data and medications affect traditional treatment models. The authors integrate the data into an evidence-based appraisal of how to best use these innovations to reduce stroke risk in this patient population.

Acute strokes have a significant impact on morbidity and mortality worldwide. Findings that stress the importance of reducing the “time to treatment”—the shorter the time, the better the outcomes—have pushed treatment approaches to center stage. A key factor is the time it takes for patients to arrive in the emergency department. One way to reduce this time is to take the treatment to the patient. Peter A. Rasmussen, MD, looks at how innovations in scanning technologies and wireless data transmissions have led to the development of spe- cially equipped mobile stroke units that can accurately differentiate the types of stroke and enable practitioners to more quickly begin appropriate thromboembolic therapy and reduce the time to therapy.

Barbara Heil, MD, and W. H. Wilson Tang, MD, review the use of cardiac biomarkers to diagnose and treat heart failure. Studies have shown the efficacy of using biomarkers to identify high-risk patients, but various factors limit their diagnostic accuracy and clinical adaptability. The authors summarize the data and explain how to incorporate biomarkers into clinical practice.

Hypertension control remains an elusive goal for practitioners. Joel Handler, MD, reviews how new evidence and innovations are revising the diagnostic guidelines and the recommended treatment strategies. He discusses innovations associated with out-of-office monitoring and new data from clinical trials that are changing the clinical practice model. He also addresses the controversy regarding systolic blood pressure goals in elderly patients and how these data have affected evidence-based guidelines.

We hope you find this supplement both informative and thought-provoking.

Physicians who were educated and began practicing in the 20th century have witnessed some of the most significant innovations and discoveries in the history of healthcare. While major surgical and therapeutic milestones defined the previous century, our current century is defined by the high-speed pace of technological innovations that affect the practice of medicine. For example, the proliferation of hand-held communication devices now provides immediate access to a wealth of healthcare information. Ultimately, recollecting information will be less necessary and far less valuable than understanding the concepts behind it. The challenge for providers is to recognize how to incorporate these innovations into the traditional model of treating diseases with the goal of improving outcomes and containing costs.

With that objective in mind, the articles in this Cleveland Clinic Journal of Medicine supplement on cardiovascular disease aim to not only review traditional treatment models for cardiovascular disease but, more importantly, to address the broad implications of new innovations on day-to-day clinical practice.

Stephanie Mick, MD, and colleagues look at how the emergence of new devices and technologies has dramatically improved the treatment of severe aortic valve stenosis and expanded the patient population eligible for aortic valve replacement. The authors review the expanded array of surgical approaches to transcatheter aortic valve replacement and the development of new devices in light of their impact on reducing the risks and improving the outcomes associated with this therapy.

Oussama Wazni, MD, and colleagues present evidence underlying the evolving strategies to prevent serious complications of stroke and thromboembolism in patients with atrial fibrillation. Newer anticoagulants are changing the strategic picture. The article includes discussion of the safety and efficacy of the available anticoagulants, as well as nonpharmacologic approaches, and considers how the new data and medications affect traditional treatment models. The authors integrate the data into an evidence-based appraisal of how to best use these innovations to reduce stroke risk in this patient population.

Acute strokes have a significant impact on morbidity and mortality worldwide. Findings that stress the importance of reducing the “time to treatment”—the shorter the time, the better the outcomes—have pushed treatment approaches to center stage. A key factor is the time it takes for patients to arrive in the emergency department. One way to reduce this time is to take the treatment to the patient. Peter A. Rasmussen, MD, looks at how innovations in scanning technologies and wireless data transmissions have led to the development of spe- cially equipped mobile stroke units that can accurately differentiate the types of stroke and enable practitioners to more quickly begin appropriate thromboembolic therapy and reduce the time to therapy.

Barbara Heil, MD, and W. H. Wilson Tang, MD, review the use of cardiac biomarkers to diagnose and treat heart failure. Studies have shown the efficacy of using biomarkers to identify high-risk patients, but various factors limit their diagnostic accuracy and clinical adaptability. The authors summarize the data and explain how to incorporate biomarkers into clinical practice.

Hypertension control remains an elusive goal for practitioners. Joel Handler, MD, reviews how new evidence and innovations are revising the diagnostic guidelines and the recommended treatment strategies. He discusses innovations associated with out-of-office monitoring and new data from clinical trials that are changing the clinical practice model. He also addresses the controversy regarding systolic blood pressure goals in elderly patients and how these data have affected evidence-based guidelines.

We hope you find this supplement both informative and thought-provoking.