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Feb 1, 2018 Issue
Beta Blockers Compared with Other Drug Options for the Treatment of Hypertension [Medicine by the Numbers]
Nebivolol/valsartan is an option for the treatment of patients with newly diagnosed or poorly controlled hypertension. Although it offers a new beta-blocker option, no research has demonstrated its benefit over existing treatments.
In this post-hoc analysis of the previously published SPRINT trial, lowering the systolic blood pressure of patients who are at increased risk of cardiovascular events (average age = 66 years) will decrease their risk of cardiovascular disease but increase their likelihood of developing moderate renal dysfunction.
Review common causes of secondary hypertension, including renovascular hypertension, renal disease, primary hyperaldosteronism, and obstructive sleep apnea.
The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) have made recommendations for all clinicians to treat hypertension in persons 60 years and older, based on the benefits and harms of higher (less than 150 mm Hg) and lower (140 mm Hg or less) systolic BP targets.
A high standard must be met when guidelines recommend lifelong preventive medications, knowing that at best, a small minority of patients will benefit and that all are risking harm.
Severely elevated blood pressure without symptoms of target organ injury can often be managed in the outpatient setting. A gradual lowering of blood pressure over several days to weeks is recommended over aggressive reduction.
It seems that rapid treatment of patients with hypertensive urgency is unsuccessful and unnecessary. In this study of almost 60,000 patients, 80% did not have controlled blood pressure (less than 140/90 mm Hg) after one month of treatment, including patients who were hospitalized. On the other hand,...
Oct 15, 2016 Issue
ACE Inhibitors or ARBs to Prevent CKD in Patients with Microalbuminuria [FPIN's Clinical Inquiries]
ACE inhibitors reduce the risk of progression to macroalbuminuria in normotensive patients with microalbuminuria and type 1 diabetes mellitus.
Although most recent practice guidelines have relaxed the blood pressure goals for patients with diabetes, there are still a few holdouts that suggest aggressive treatment. This analysis shows that the ideal range for hypertension control in patients with diabetes is between 140 and 150 mm Hg; highe...