A Fresh Approach to Understanding Clinical Hypertension

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With advances in the field of nephrology broadening our
knowledge of transplant medicine, glomerular disease, and the interventional aspects
of access, I believe fellowship training in the traditional areas of the
specialty such as hypertension have diminished.
And yet, apart antibiotics, anti-hypertensives are the
single most important therapy contributing to rising life expectancies. Because
while ESRD trials focus on endpoints such as PTH levels and the CKD literature
uses outcomes such as a doubling of serum creatinine, hypertension studies utilize
clinical endpoints such as all cause
.  Moreover, it’s a
fascinating disease, our understanding of which is unrivaled by any other
condition. What is the circadian rhythm of blood pressure? How does pulse
pressure affect the risk of CAD? What is the relationship between basal heart
rate and mortality? To understand hypertension is to appreciate human
physiology, to apply evidence-based medicine, and to practice cost effective care.
Moreover, despite the proliferation of national treatment guidelines,
management is more nuanced than targeting similar blood pressure levels for all
patients and prescribing the same handful of agents. The “art” of management hinges
on understanding the difference between metoprolol and betaxolol,
hydrochlorthiazide and indapamide, and losartan and azilsartan. As such, if
there is one disease to know, and know well it’s hypertension.
To improve my own knowledge of the above, I’m currently undertaking
an additional fellowship in hypertension under George Bakris at the hypertension
center here at the University of Chicago. In order to share what I have learned,
I’ve created a bi-weekly e-newsletter, “Concepts in Hypertension,” as a non-commercial medium to convey key aspects of the
disease. Each issue is concise,
summarizing one seminal paper and
underscoring one key concept. The
newsletter then ends with a “clinical perspective” that indicates how the
selected paper informs the management of patients at our hypertension center.
Below are several recent issues. If you’d like to subscribe
to this free, non-commercial publication, you can do so by visiting www.bp-specialists.com/newsletter
Hillel Sternlicht
The University of Chicago

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