September 27th 2024
Your daily dose of the clinical news you may have missed.
Treatment Dilemma: Favorable Lipid Ratio With an Elevated LDL
June 1st 2007Is it necessary to prescribe lipid-lowering therapy for a patient with a mildly elevated total cholesterol level (240 mg/dL), a low-density lipoprotein (LDL) cholesterol level of 120 mg/dL, and a high high-density lipoprotein (HDL) cholesterol level of 100 mg/dL?
Elevated Hematocrit in Man Receiving Hemodialysis
June 1st 2007A 50-year-old man with end-stage renal disease secondary to long-standing hypertension had an elevated hematocrit and progressively increasing hemoglobin levels. For the past 7 years, he had been receiving hemodialysis 3 times a week. He denied headache, flushing, easy bruising, bleeding, nausea, vomiting, chest pain, dyspnea, and other symptoms. He was not receiving exogenous erythropoietin.
Low Birth Weight Spells Adult Risk for Diabetes and Hypertension
May 16th 2007HELSINKI, Finland -- When babies born prematurely with a low birth weight become young adults, they are likely to have higher levels of insulin resistance, glucose intolerance, and higher blood pressure than those born at term, researchers here reported.
Reviewers Question First In-Class Rennin Inhibitor for Hypertension
May 11th 2007NEW YORK -- Aliskiren, the first oral antihypertensive agent in the renin-inhibitor class, is no better at reducing blood pressure than older agents, and in some patients may actually increase blood pressure, claimed two reviewers.
Postpartum pulmonary arterial hypertension
May 1st 2007Patients with congenital heart disease and pulmonary arterial hypertension (PAH) are at risk for severe deterioration during pregnancy and delivery. We discuss the case of a 38-year-old woman who presented to the emergency department complaining of dyspnea 6 days after giving birth to her first child via cesare- an section. When PAH is untreated, maternal mortality may exceed 50%, but aggressive PAH treatment offers improved outcomes. Moreover, initial improvement in functional status made with parenteral prostanoids can be maintained with combination oral therapy.
Asymptomatic Smoker Who Requests Lung Cancer Screening
May 1st 2007A 57-year-old man requests an extensive medical evaluation as part of a transition in the ownership of his business. He is generally healthy, although he reports that his capacity for physical exertion has diminished over the past several years. He denies chest pain with effort, dyspnea at night or on exertion, cough, and sputum production.
Preventing Reinfarction: Basic Elements of an Effective Cardiac Rehabilitation Program
May 1st 2007ABSTRACT: Patients who experience an acute myocardial infarction (MI) are at very high risk for recurrent cardiovascular events. Both site-supervised and home-based cardiac rehabilitation programs can effectively reduce all-cause and cardiovascular mortality. Start risk factor reduction as soon as possible; pharmacotherapy is best initiated while patients are still in the hospital. All patients who have had an MI should receive aspirin, an angiotensin-converting enzyme inhibitor, and a ß-blocker, unless these agents are contraindicated or are not tolerated. Prescribe aggressive lipid-lowering therapy to bring patients' low-density lipoprotein cholesterol levels to below 70 mg/dL. For smokers, quitting is the single most important change they can make to reduce future risk of MI.
Making Sense Out of an Alphabet Soup of Hypertension Treatment Studies
April 1st 2007Numerous randomized trials have evaluated antihypertensive regimens in various settings, including those complicated by at least one other vascular disorder. Among these trials are the Modification of Diet in Renal Disease (MDRD) Study in hypertensive patients with kidney disease; the Comparison of AMlodipine versus Enalapril to Limit Occurrences of Thrombosis (CAMELOT) Study and the INternational VErapamil-trandolapril STudy (INVEST) in patients with hypertension and coronary disease; and the Perindopril pROtection aGainst REcurrence of Stroke Study (PROGRESS) in hypertensive patients who have had a stroke.
AHA Suggests Heart Screening Instead of Routine ECGs for Young Athletes
March 13th 2007DALLAS -- Pre-participation cardiovascular evaluation of young competitive athletes to rule out Marfan syndrome, murmur, aortic coarctation, and hypertension could reduce the risk of sudden death, contend new guidelines.
Diastolic blood pressure: How low can you go?
March 1st 2007**Until the 1990s, hypertension was largely defined using only the criterion of elevated DBP. However, with the aging and increased longevity of the population, the incidence of predominantly systolic hypertension is on the rise. Isolated systolic hypertension (ISH) is now the most common subtype of hypertension in American adults. The third National Health and Nutrition Examination Survey (NHANES III, 1988-1991) reported that 75% of persons with hypertension were 50 years or older and that about 80% of those untreated or inadequately treated had ISH.1
A Stand-Up Approach to Diagnosing Orthostatic Hypotension
March 1st 2007Although the definition of orthostatic hypotension requires that the significant drop in blood pressure observed on standing be sustained for 3 minutes (which provides evidence of true autonomic failure), clinicians who use this as a diagnostic criterion may be doing many patients a disservice. Most people who fall as a result of a drop in blood pressure do so on arising, as they get up from a bed or chair. Moreover, many hip fractures caused by falls occur in patients who experience a drop in blood pressure on standing. If patients can stand for 3 minutes without wavering or falling, their body is accommodating well.