Hypertension

As more angiotensin receptor blockers come off patent, it will be interesting to see how manufacturers, payers, and physicians react.

Treating high blood pressure in African-Americans needs to start sooner and be more aggressive, according to a statement by the ISHIB.

Following the DASH diet can reduce blood pressure, lower bad cholesterol, and decrease 10-year-risk of heart attack.

I thought I lost a patient a few weeks ago. No, he didn't die, but after his office visit, I had the distinct impression that he might not come back. My job is to take care of my patients' health. But sometimes I'm just the messenger.

Online medical records aren't very useful if no one can access them.

As baby boomers enter their golden years, they are facing a catch-22: while they can expect to live longer due to advances in medicine, they will also be facing situations where they will be unable to care for themselves.

I am convinced that we essentially sabotage both our guests and ourselves when we offer only these high calorie and often totally unhealthy options time and time again.

The article by Rehman and colleagues (page 27) offers two important observations about the control of hypertension in African American men.

For 50 years, hypertension has been recognized as the most significant risk factor for the development of symptomatic cardiovascular disease in Western society.

More important than the choice of pharmaceutical agent in the treatment of elderly hypertensive patients is the achievement of goal blood pressure. Low-dose diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers are equally effective in reducing cardiovascular end points. Most patients will require 2 or more drugs to achieve target blood pressure, and physicians should feel comfortable prescribing 3 to 4 agents to a significant proportion of patients.

We assessed whether C-reactive protein (CRP) concentrations predicted future risk of hypertension in a cohort of young adults. Results showed that CRP levels do not independently predict risk of incident hypertension after accounting for body mass index. Further research is needed in the area of inflammation and hypertension, with a special focus on the effect of obesity and age-related changes on this process.

Is hypertension an inflammatory disease?

This study evaluated whether exogenous insulin use to control blood glucose in patients with type 2 diabetes was associated with the development of hypertension by analyzing data obtained from a large national sample in Taiwan. Exogenous insulin use was shown to be a significant risk factor for hypertension development.

Insulin resistance has been linked to an increased risk of hypertension, type 2 diabetes mellitus, and cardiovascular disease.

Diabetic cardiomyopathy is a clinical condition characterized by altered myocardial function in the absence of coronary artery disease, hypertension, and valvular or congenital heart disease. Patients with this condition exhibit changes in cardiac structure that may be attributed to the direct effect of diabetes mellitus. The author discusses the mechanisms, risk factors, screening, diagnosis, prevention, and treatment of cardiomyopathy in patients with diabetes.

Over a period of 14 years, we followed 282 patients aged 70 years or older who were hospitalized with heart failure. Median survival was 2.5 years, but 25% of patients died within 1 year, and 25% survived for at least 5 years following hospital discharge. A simple 7-item risk score based on data readily available at the time of hospitalization effectively stratified patients into low-, intermediate-, and high-risk categories for subsequent mortality.

We assessed the association between the incidence of coronary heart disease and alcohol consumption among hypertensive men enrolled in the Health "Professionals" Follow-Up Study. Moderate alcohol consumption (1 to 2 drinks per day) was associated with a lower risk of myocardial infarction, as in the general population, but was not associated with the risks of stroke, total mortality, or mortality from cardiovascular causes. These results show that men with hypertension who drink moderately may not need to change their drinking habits.

Stroke is an especially important disease to study in terms of secular trends because it is so common, deadly, and disabling.

We evaluated the prevalence of primary aldosteronism in subjects newly diagnosed with hypertension who were referred to specialized hypertension centers. An aldosterone-producing adenoma was diagnosed in the subjects with lateralized aldosterone secretion, adenoma at surgery and on pathologic evaluation, and a blood pressure fall after adrenalectomy. Evidence of excess autonomous aldosterone secretion without such criteria led to a diagnosis of idiopathic hyperaldosteronism. Aldosterone-producing adenoma and idiopathic hyperaldosteronism were conclusively diagnosed in 4.8% and 6.4% of the subjects, respectively. Thus, with a prevalence of 11.2%, primary aldosteronism is quite common in patients with newly diagnosed hypertension.

To determine whether alcohol-associated hypertension carries risks similar to those of hypertension in abstainers or light drinkers, we prospectively studied cardiovascular sequelae separately in heavy drinkers, light drinkers, and abstainers. The risk of all outcomes was progressively higher for increasing blood pressure categories, with similar associations in each alcohol category. These data indicate that the risks of hypertension are independent of the amount of alcohol intake.

Klatsky reports a link between elevated blood pressures and increased risk of hospitalizations for coronary heart disease and stroke that is independent of alcohol intake.

Atrial fibrillation (AF) is the most common arrhythmia, accounting for approximately one third of all patient discharges with arrhythmia as the principal diagnosis and the greatest number of hospitalization days for arrhythmia each year.