Under Pressure
As a medical student I was taught the CKD hypertension gospel straight from the good book of JNC VII: Thou shalt lower the blood pressure to less than 130/80! This was many years after David Bowe and Freddie…
Pregnancy and ACE inhibitors
Treating hypertension on pregnancy sometimes feels a little like going back in time. As Nate posted previously, the list of anti-hypertensives that are considered safe in pregnancy is relatively short – first line agents include labetalol, hydralazine, methyldopa…
Resistant Hypertension: breaking the barrier
We are frequently faced with patients on multiple anti-hypertensives still with poorly controlled BP levels. I learned some very interesting points on an article at CJASN from Dr Townsend on how to approach the management of those patients:…
Guyton was right all along: The primacy of the kidneys (and NaCl) in causing essential hypertension
Dr. Arthur C. Guyton (1919-2003) was one of the greatest physiologists of our time. One of Dr. Guyton’s many seminal contributions to medicine was to establish the role of kidneys in long-term blood pressure regulation via a mechanism…
Multiple renal arteries and hypertension?
A woman in her 30’s presented with five years of severe hypertension, uncontrolled on trials of four or five agents over the past few years. She had had preeclampsia nine years ago that resolved after delivery, and for…
Is lower salt intake bad for you – evidence?
An observational study of urinary sodium excretion (a surrogate of dietary salt intake) and it’s association with cardiovascular mortality was published in JAMA last week. The trial involved 3681 patients in Europe without cardiovascular disease at baseline. The…
Tell me who your friends are and I will tell you who you are: NaHCO3 isn’t NaCl
When managing patients with metabolic acidosis, some nephrologists are afraid of prescribing NaHCO3 because of the potential adverse consequences of increasing ECF volume and worsening blood pressure. However, there is significant evidence that the kidneys handle NaCl in…
NKF Spring Clinical Meeting – BP in CKD
I attended a very interesting talk from Dr Bakris today on the latest approaches to BP targets in the CKD population. The highlights are nicely illustrated in a systematic review published in the Annals this year. They searched…
Cut out the salt
Cutting back your salt intake is an effective way to reduce systolic and diastolic blood pressure and decrease your risk of dying from cardiovascular disease. The current guidelines suggest that we should reduce our dietary sodium intake to…
Evaluation of primary aldosteronism: seeing is not believing
As you would have likely guessed by looking at the picture to the left we often tend to believe what we see without giving much thought. This is frequently true in the evaluation and management of patients with…