Hypertension

No longer considered a single entity, hypertension is part of a larger disease group that includes obesity, diabetes mellitus, kidney disease, and other concerns. Test your knowledge of hypertension and related problems.

Here: factors that can affect home BP readings . . .when to start antiretroviral therapy . . . coping strategies for the challenges of aging . . . triggers to avoid in hyperthyroid patients . . . insights into causes of childhood obesity.

There may be a difficult tradeoff between treating patients with hypertension and preventing serious fall injuries.

Certain modifiable risk factors-ncluding heart rate, smoking status, and antihypertensive medications-affect blood pressure in patients with type 2 diabetes mellitus. And variability in blood pressure has an important role in progression of organ damage.

There would be more blood pressures available for review and no confounding readings because of the white coat effect.

Where are we left after a flurry of hypertension publications as 2013 was ending and 2014 beginning? Let’s summarize our recent encounters with the available facts.

If you combine the simplified targets found in JNC 8 with the practical directions offered by the ASH 2013 update, will you actually reach the elusive destination (hypertension control)? Maybe. More, here.

I can see the target destinations on the JNC map, but I need a car and gas to get there.

Here: 9 recommendations that comprise the latest JNC 8 guidelines. Was it worth the wait?

Here: 5 questions that test your knowledge of gout, psoriasis, COPD, and dermatologic lesions.

Warning: The maximum daily dose of a single dispersible medication may itself contain more sodium than is recommended from all sources in a day.

The revised guidelines relax some BP targets, incorporate daytime ambulatory and nocturnal BP measures, and recommend that the decision to treat be based on a patient's overall cardiovascular health.

Patients with type 2 diabetes mellitus should be monitored with ABPM if they are at high risk for cardiovascular complications, according to the results of a new study.

I was taught how to take blood pressures early in medical school. If a few “dos and don’ts” were respected, things seemed to proceed uneventfully (with attention to cuff placement and size, Korotkoff sounds, etc).

Vitamin D supplementation in the VitDISH study did not improve isolated systolic hypertension in elderly patients who were deficient.

There is not enough evidence to assess the benefit or harm, according to an update from the U S Preventive Services Task Force.

This case focuses on duplicate therapy resulting from the use of prescription medications, which can result in serious adverse effects.

Potassium, an important component of blood pressure regulation, has been relatively forgotten.

Any antihypertensive agent, but especially ACEIs, may cause hypotension if not discontinued in the perioperative period.

Aldosterone has significant effects on vascular function and can decrease flow-mediated vasodilation.

Equivalent energy expended while walking vs running translates into comparable risk reduction for incident hypertension, elevated cholesterol, and diabetes.

A large-scale hypertension program was associated with a significant increase in hypertension control compared with state and national control rates, according to a recent JAMA study.

Nonadherence to antihypertensive drug therapy increased risk of stroke, hospitalization for stroke and stroke-related mortality.

Mid-life hypertension is a risk factor for cognitive decline. A 10 mm Hg rise in systolic pressure led to an intermediate cognitive decline in 7% of the cohort on follow-up.

At the ASH meeting, one could get a pretty good sense of where the beta-blocker hypertension debate is headed.

Adult-onset psoriasis is uncommon without a precipitating factor. In this patient’s case, an oral beta-blocker precipitated the psoriasis.

Yoga practice resulted in a 3-4 mm Hg decline in systolic BP at 24 weeks and a 2-3 mm Hg decline in diastolic BP on 24-hour ambulatory monitoring.

Awareness of this major health problem is on the rise, as evidenced by numerous recent reports about important new study findings.

The number of people who require 2 or more antihypertensives to reach target blood pressure is on the increase. So, simply stated, what goes best with what? The 2013 ASH meeting offered some good suggestions under the heading of “Within Class Differences.”