Hypertension

Blueberries and strawberries contain high concentrations of anthocyanins, a flavonoid shown to help lower blood pressure and improve endothelial function.

The FDA requires reductions in recommended doses of zolpidem; update on the flu; new BP goals for patients with diabetes; selective use of D-Dimer for suspected DVT; new food safety standards. . . here: 5 quick summaries of medical news headlines with links out to original sources.

Here: a battle plan to address obesity-the root problem of our current epidemic of metabolic syndrome, hypertension, and diabetes mellitus-that involves kicking a sedentary lifestyle.

The benefits of antihypertensives in the elderly should be unquestioned-especially since SHEP and its revisit. Avoiding them will create more problems. But caution can be exercised with these specific measures.

Emphysematous cholecystitis is a rare condition that is the result of infection with Clostridium perfringens and other gas-producing organisms including Escherichia coli, Bacteroides fragilis, and Klebsiella species.

More than half of adults 65 years and older have at least 3 chronic conditions, such as heart disease, diabetes mellitus, arthritis, high blood pressure, and Alzheimer disease, according to the American Geriatrics Society.

Insomnia can have serious consequences for patients who already have high blood pressure, according to a new study presented at the American Heart Association’s High Blood Pressure Research 2012 Scientific Sessions.

Hyperglycemia uncontrolled by oral antidiabetes agents alone can be complicated by drug-induced weight gain. GLP-1 agonists and DPP-4 inhibitors offer alternatives.

Hypertension is very common in people with diabetes; in this patient’s case, it may have been present for 5 to 10 years before the hyperglycemia appeared.

In addition to lifestyle changes, how would you treat this patient?

Persons with primary hyperaldosteronism and hypertension are at significantly increased risk for cardiovascular morbidity and mortality. But if these patients are treated with spironolactone and reach target blood pressure, their CV outcomes are the same as those of others with essential hypertension after 6.5 years of follow-up.

The key diagnostic considerations hypokalemia, periodic paralysis, and ischemia should lead the assessment of a patient with acute generalized weakness.

Neither chlorthalidone nor spironolactone can be ignored in today's antihypertensive armamentarium. Both agents, alone or in combination, have appealing indications.

A 22-year follow-up of the SHEP study cohort showed that each month of active treatment with chlorthalidone was associated with a 1-day extension of life.

Autosomal dominant polycystic kidney disease (ADPKD) is common. Presenting symtpoms include hypertension, hematuria, proteinuria, and renal insufficiency.

What newer options are available to lower blood pressure in resistant hypertension? What about renal sympathetic denervation?

Diabetic peripheral neuropathy may develop in patients who have normal or impaired fasting blood glucose or impaired glucose tolerance, precursors to frank diabetes.

A 58-year-old man presents with myalgias of approximately 1 week’s duration. He had been recently treated for sinusitis and symptoms resolved. His only medications were hydrochlorothiazide for hypertension and simvastatin for hyperlipidemia. He and his wife had gone camping 1 month before this visit.

A 47-year-old man sees you for a check-up. He complains only of low energy and attributes it to recent weight gain. But, there is much more.

Unfortunately, the growing epidemics of hypertension and gout are often a package deal. Recent data demonstrate that 74% of people with gout are also hypertensive.

Dizzy patient? Their brain might not be getting enough blood, thanks to their antihypertensive dosage.

During my residency in medicine, and for a generation after, ß-blockers were among first choices for lowering blood pressure. Now it seems that ß-blockers have evolved into disreputable antihypertensives. What’s changed over a generation?

A 50-year-old African American woman with type 2 diabetes mellitus and hypertension was admitted with constant bilateral knee and thigh pain and swelling of both knees, all of 1 week’s duration. The pain was not relieved with hydrocodone/acetaminophen and had caused weakness and subsequent falls.

Prevalence for overweight (BMI 24.9 to 29.9) and obesity (BMI > 30) have been steadily rising for the past 30 years-two-thirds of Americans now qualify as overweight or heavier. Hypertension, hyperlipidemia, coronary artery disease, type 2 diabetes, sleep apnea, and GERD prevalence are following this epidemic. Obesity is now the second most common preventable cause of death, exceeded only by smoking.

Gout, once considered a disease of kings, is now a common and equal opportunity disease that affects as many as 3 million people in the US. Gouty arthritis has now become a serious problem in organ transplant recipients; in diuretic users; and in patients with CKD, hypertension, metabolic syndrome, heart failure, plus more.

The authors’ opening salvo seems to say it all (again). . . “A patient’s nocturnal BP profile, without the pressor effect of physical activity, emotional stress, and environmental factors that are usually present during the day, is more representative of the true BP status and a stronger predictor of cardiovascular outcomes.”

Typically, antihypertensive medications are taken in the morning. But typically does not always equal correct! Preliminary studies have documented that a more appropriate approach would be to take them (or at least some of them) at bedtime.