MD Consult - Find The Answer

When looking at the highest causes of preventable deaths in the United States it’s easy to put a check next to smoking, alcohol abuse, and drug use, but what about hypertension?  Millions of Americans have uncontrolled hypertension causing their blood pressure to go unchecked.  In fact, there are a large number of people who, even though they are undergoing treatment for high blood pressure, still do not have it under control.

The article posted on MD Consult quoted the National Health and Nutrition Examination Survey saying that, “The condition is deemed uncontrolled in approximately 35.8 million of [the 66.9 million American adults with hypertension]. Further, while an estimated 14.1 million of these adults were not aware of their hypertension, roughly 16 million were aware and receiving treatment for it; another 5.7 million were aware, but were not being treated.”

Thomas R. Frieden of the Centers for Disease Control and Prevention believes that “We have to roll up our sleeves and make blood pressure control a priority at every visit….We have to engage the entire health care team, including pharmacists, nurses, nutritionists, office staff to optimize patient support and follow-up care.”

As if it were a sister piece to the aforementioned article, a story was published listing common myths in controlling hypertension.

It began by listing a widespread misconception about treatment:  “Monotherapy is the best initial approach to reducing blood pressure.”  It has been a practice for years to simply keep increasing the dosage of one drug that works. The article suggests that there be at least a diuretic added into the mix.

This lead to the myths in question:

• Diuretics are interchangeable: They’re not. The two most common used for hypertension, chlorthalidone and hydrochlorothiazide, have very different characteristics.

• Beta-blockers are tops: They’re not. “…There’s less and less evidence supporting the use of beta-blockers for pure, garden-variety hypertension,” Dr. Stephen S. Mehler is quoted as saying.

• There’s no J-curve: There is. Probably. Let’s just say it’s up for argument. But it applies to diastolic and not to systolic blood pressure.

• Salt, schmalt!: Cut back. The restriction of salt in one’s diet is extremely beneficial to the treatment of hypertension. Dr. Mehler likens the benefits to the affects of quitting smoking or adding a new class of medication to your treatment regime.

• No hypokalemia means any primary hyperaldosteronism: That might not be the case. “In the past, the diagnosis of primary hypoaldosteronism leaned heavily on the presence of hypokalemia. More recently, however, studies demonstrate that normokalemic hypertension is the most common presentation of primary hyperaldosteronism; hypokalemia is present in only 9%-37% of cases, and these tend to be the most severe ones.”

Check back again next week to find out what else is new on MD Consult!

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