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226 Q&A related to Hypertension

First steps in proteinuria | Nephrology | 12-2011
Clinical history and physical examination are important initial steps in evaluating patients with asymptomatic proteinuria, especially the history of diabetes, hypertension, family history of kidney disease, history of collagen disorder, ...

No escaping history | Cardiology | 08-2011
The trials do not evaluate this concept, though it certainly makes clinical sense that well-treated blood pressure has a lower stroke rate. But strictly speaking, in the Chads scoring system, ...

Black holes in white matter | Neurology | 04-2011
Lacunes from the Latin word for hole, pit, or lake are small infarcts deep in the brain and were probably first described pathologically in 1843 by Durant-Fardel. The clinical presentations ...

Listen to your heart | Cardiology | 02-2011
People do sometimes hear their pulse quite loudly in their ear when lying in certain positions. For most people this happens only occasionally. It s normal, of course, to hear ...

Bringing closure | Cardiology | 02-2011
Up to 30 of Canadians have a PFO that is still detectable in adult life. The how of closure is considerably simpler than the when or whether , but in ...

Beta-blocker eyedrops can have systemic effects | Ophthalmology | 12-2010
Beta-blockers are some of the most effective pharmacologic agents to reduce intraocular pressure in ocular conditions such as glaucoma. In Canada, there are three agents currently approved for topical ophthalmic ...

Thiazide diuretics and gout: found not guilty on re-trial | Nephrology | 12-2010
Metabolic side effects from recommended doses of thiazide diuretics for treatment of hypertension are dose-dependent and often minimal. In fact, the indications where diuretics are used hypertension, cardiovascular disease are ...

Renal cysts: when to worry | Nephrology | 09-2010
Renal cysts are the most common incidentally noted abnormalities on imaging studies. Their frequency increases with age, affecting over half of the population over age 50. The clinically relevant question, ...

Salt kills | Cardiology | 09-2010
Simply stated, salt kills A number of years ago a meta-analysis of sodium restriction led to a long-term reduction in total mortality of 30 . I think it s criminal ...

The Mamas and the PAPP-As | Ob/Gyn | 08-2010
Pregnancy-associated plasma protein A is a protein produced by the placental trophoblasts and is one of the markers used in prenatal genetic testing. Low levels of this protein are a ...

Salt counts for plenty in BP | Cardiology | 06-2010
There s clear data that salt is associated with the development of hypertension in healthy populations. Recently, a small randomized crossover study examined the role of salt sensitivity in resistant ...

A second look at seniors’ drugs | Geriatrics | 05-2010
In Canada, seniors account for approximately 14 of the population yet receive 40 of prescriptions. This is undoubtedly related to the multiple co-morbidities of the elderly. With evidence-based guidelines for ...

Anti-depressant bias | Psychiatry | 05-2010
Treatment refusal is a difficult problem that s somewhat different from simple non-compliance. The reasons may be numerous and they must be explored. Common reasons for not wanting to use ...

The Pill: best avoided in hypertension and kidney disease | Nephrology | 04-2010
The selection of a birth control device depends on the degree of hypertension, and the type and degree of underlying kidney disease. Generally, women who have high blood pressure should ...

White matter, red flag | Imaging | 04-2010
Multiple white matter hyperdense lesions WMLs describes a vague general pattern that can be associated with a myriad of etiologies, some benign, some more concerning. Of course the significance of ...

Be still my beating heart | Cardiology | 03-2010
Any time you lower blood pressure significantly, you should expect a reflex tachycardia, but most the time, the BP is lowered gradually and within acceptable parameters. The change in heart ...

Vitamin D — it’s all good | Clinical Pharmacology | 02-2010
In northern counties such as Canada relative vitamin D deficiency is much more common than is often appreciated, with the attendant risk of reduced bone density and, over time, fracture. ...

Beta-blockers: safe option in asthma? | Clinical Pharmacology | 02-2010
This is an excellent question, as the mainstay of therapy for acute exacerbations of asthma relies on bronchodilation produced by beta-1 agonists such as salbutamol. Thus, classical teaching has suggested ...

ACE plus ARB for rising ACR? | Cardiology | 01-2010
I ve never had a patient come back and say to me, Doctor, I feel so much better now that I m putting out less albumin or protein in my ...

Alpha-fetoprotein often signals placenta problems | Ob/Gyn | 12-2009
Rises in maternal levels of alpha-fetoprotein during pregnancy are considered unexplained if they occur in the absence of fetal chromosomal abnormalities, fetal structural anomalies for example, open neural tube defects, ...

Microalbuminuria keeps climbing | Nephrology | 04-2009
You didn rsquo t mention the patient rsquo s age and life expectancy. It rsquo s important to know the risk factors, general health status, co-morbid conditions and life expectancy ...

Targeting BP — sparing the kidney | Nephrology | 02-2009
Hypertension guidelines such as the Canadian Hypertension Education Program CHEP recommend agents affecting the Renin-Angiotensin-Aldosterone System RAAS , as the best choice for controlling blood pressure BP in patients with ...

Catching them young in type II diabetes | Cardiology | 02-2009
Young patients with new onset diabetes have a low short-term clinical risk of developing vascular complications. Younger female patients of childbearing age particularly shouldn t be started on statins due ...

Treating antipho­spholipid syndrome | Hematology | 02-2009
Hematologist response Antiphospholipid syndrome APS is an acquired autoimmune disorder characterized by a wide variety of clinical manifestations as the result of arterial and venous thrombosis, often recurrent, and pregnancy ...

High systolic, low diastolic: what can it mean? | Cardiology | 01-2009
Often, elderly patients have isolated systolic hypertension indicative of poor vascular wall compliance, which presents with a widened pulse pressure. In elderly patients, this is a marker for stiff arteries ...

Do kidney donors get fair warning? | Nephrology | 01-2009
The short- and long-term risks associated with kidney donation are generally small. In the short term, there s the risk of bleeding or infection in the perioperative period. Death from ...

Are BP monitors harming doctors? | Clinical Pharmacology | 01-2009
Mercury is an interesting metal, toxic in certain forms yet fairly innocuous in others. Mercury exists in several forms, elemental metallic , inorganic and organic. The mercury in blood pressure ...

CPAP for a nap? | Respirology | 11-2008
Yes, they should, as the reason for using CPAP is to prevent hypoxia during sleep any sleep. Hypoxia can lead to significant adverse effects such as pulmonary hypertension, arrhythmias, erythrocytosis, ...

Advanced renal failure: how to get the BP down | Cardiology | 11-2008
As renal function declines, thiazide diuretics become less effective. In most patients with creatinine gt 150 mol L or creatinine clearance lt 30 mL min, these meds will be relatively ...

Regular tune-up for BP instruments | Cardiology | 09-2008
I found an article by S.A. Yarrows in the American Journal of Hypertension to be helpful regarding proper maintenance and calibration of BP machines. Unfortunately, it doesn't lay out specific ...

Which meds preclude blood donation? | Hematology | 07-2008
The list is extensive -- because some may harm the recipient and others the donor. Before accepting a donation, Canadian Blood Services first asks the person a number of questions ...

Incidental fatty liver finding: is it serious? | Gastroenterology | 05-2008
An incidental finding of a fatty liver on an ultrasound is important -- rather like other silent conditions like hyperlipidemia and hypertension. It can progress to steatohepatitis and cirrhosis in ...

Balancing diuretics to treat pleural effusion | Respirology, Cardiology | 03-2008
Chronic elevation of right atrial pressure or pulmonary arterial pressure, or both, isn't a cause of pleural effusion if it occurs in isolation, according to at least one study Chest ...

Make the right OC choices | Ob/Gyn, Neurology | 03-2008
The response of migraine to initiation of OCs varies between patients. Many show no change in headache pattern, a few improve and some worsen. Epidemiologic studies suggest that migraine and ...

Unexpected uses for sildenafil | Cardiology, Clinical Pharmacology | 02-2008
There are a number of off-label indications for which nobody really has any data beyond better sexual satisfaction. The major one that comes to mind is in the treatment of ...

Unexpected uses for sildenafil | Clinical Pharmacology | 02-2008
Sildenafil is an oral phosphodiesterase inhibitor known to produce smooth muscle relaxation. This is the basis of its efficacy in treating erectile dysfunction. It has also been used for relieving ...

Preventing hyponatremia in nursing homes | Geriatrics | 02-2008
Although hyponatremia is usually defined as a plasma sodium 135 mm L, the frail elderly, particularly those with cognitive vulnerability, may show increased confusion when sodium levels fall under 130. ...

Interpreting eGFR in older adults (our geriatric specialist responds) | Nephrology, Geriatrics | 01-2008
The GFR progressively declines with age. After age 40, it decreases at a rate of 8-10 mL min 1.73 m2 per decade. In one study, people age 30 had an ...

Clues to thoracic aortic dissection | Cardiology | 01-2008
You're right in the importance of having a high index of suspicion for this life-threatening medical condition. In acute dissection, the most sensitive symptoms -- that present in 90 of ...

What's the evidence for statins in prevention? | Cardiology | 11-2007
There are multiple trials that demonstrate the value of statins in high-risk primary prevention, e.g. the West of Scotland Coronary Prevention Study WOSCOPS with pravastatin. The Anglo-Scandinavian Cardiac Outcomes Trial ...

Sodium savvy: is sea salt really better? | Cardiology | 11-2007
Unfortunately, salt is salt. Encouraging the use of sea salt is just a marketing strategy because it still contains the same amount of sodium chloride that leads to hypertension. Remember ...

Sodium savvy: is sea salt really better? | Clinical Pharmacology | 11-2007
Sea salt is produced by evaporation, so it contains traces of minerals that change the texture and taste somewhat. This aside, there's no difference between table salt and sea salt ...

Are drug store BP machines accurate? | Cardiology | 08-2007
A number of studies have suggested that many BP machines in pharmacies may not always be accurate. It's still worthwhile, though, for patients to measure their BP in multiple locations, ...

How to quit beta-blockers | Cardiology | 06-2007
As you're well aware, the Canadian Hypertension Society no longer recommends beta-blockers as first-line therapy in the management of uncomplicated hypertension in individuals aged 60 or older. These drugs are ...

Which patients really need diet pills? | Endocrinology | 06-2007
Overweight is defined as a body mass index BMI amp gt 27 kg m amp lt sup amp gt 2 amp lt sup amp gt . Obesity refers to a ...

Does high systemic BP build to glaucoma? | Ophthalmology | 05-2007
The association between systemic hypertension and glaucoma is debatable, given the high incidence of high blood pressure in the age group that develops glaucoma. Any associated increased risk is small, ...

Can shockwave lithotripsy induce diabetes? | Nephrology | 03-2007
Hypertension following shockwave lithotripsy has been the subject of controversy since the 1980s. A few studies initially supported this effect but other short trials with follow-ups to 5 years failed ...

When is a methacholine challenge indicated? | Respirology | 02-2007
A methacholine challenge test is the repeated administration of increasing doses of a cholinergic agent, methacholine, to induce a 20 fall in the patient's forced expiratory volume FEV amp lt ...

Managing drug-induced metabolic syndrome | Endocrinology | 01-2007
Individuals with metabolic syndrome caused by novel antipsychotics should be treated as any other patient with metabolic syndrome. Place the emphasis on weight reduction and management of risk factors, such ...

When to use CPAP for sleep apnea | Respirology | 12-2006
First, every patient should be evaluated for all factors -- i.e. disability from their disease, occupation e.g. truck driver and barriers such as cost. To make the diagnosis, however, sleep ...

Diagnosing arcuate ligament syndrome | Imaging | 11-2006
The median arcuate ligament is a fibrous arch that joins the diaphragmatic crura on either side of the aortic hiatus at the thoracoabdominal junction. It usually passes superior to the ...

Disturbed over a dropped kidney | Nephrology | 11-2006
A ptotic or dropped kidney, otherwise known as nephroptosis, is a congenital abnormality where the kidney is situated at a lower place than usual, i.e., in the pelvis or next ...

When MIBI scan conflicts with angiogram | Imaging | 10-2006
In discussions with our cardiologists, this is a common problem, and one that's generally dealt with by reassuring the patient that there's no cause for concern. The conventional catheter angiogram ...

COPD: when to give oxygen | Respirology | 10-2006
There's evidence that oxygen is indicated when the arterial oxygen tension PaO amp lt sub amp gt 2 amp lt sub amp gt is less than 55 mm Hg, which ...

Atrial fib: is laser recommended? | Cardiology | 09-2006
I treat atrial fibrillation for two basic reasons. First, it's important to prevent stroke. In this situation, warfarin therapy is the treatment of choice. Studies have shown that it reduces ...

Renal disorders: can NSAIDs be prescribed? | Nephrology | 06-2006
Selective NSAIDs, such as cyclooxygenase-2 COX-2 inhibitors, and non-selective agents are commonly used for managing pain. The enzyme COX-2 is constitutively expressed in the kidney and is highly regulated in ...

Do beta-blockers worsen ED? | Cardiology | 04-2006
Erectile dysfunction is common in patients with vascular disease, and it's always a challenge to sort out whether the medication is a cause or an aggravating factor. The best randomized ...

Best Tx options for hypertension in seniors | Geriatrics | 04-2006
Hypertension, as defined by a BP amp amp 155 140 90 mm Hg, affects 60-80 in the population over age 65. There's clear evidence of the benefit of treatment in ...

Are non-specific ST-T changes significant? | Cardiology | 03-2006
Unfortunately, vascular disease becomes more prevalent as we age. After a man's 50th birthday, the incidence rises significantly. The ECG characteristics that you describe as non-specific, however, constitute a change ...

Atrial fib: should ASA be added to warfarin? | Cardiology | 03-2006
Atrial fibrillation is the most frequent arrhythmia of the elderly, occurring in more than 10 of people over the age of 70 years. As the Canadian population continues to age, ...

When should patients forego flying? | Cardiology | 03-2006
Air travel poses stressors on a patient, from the general such as moving through crowded airports, to the specific related to aircraft environment. Most importantly, flight entails reduced barometric pressure, ...

To treat or not to treat: a question of lifespan | Nephrology | 01-2006
In epidemiologic studies, it's been estimated that the lifespan decreases by 10-20 years without treatment of hypertension, diabetes and obesity amp amp 151 the common risk factors for atherosclerosis. In ...

Are inflammatory disorders tied to CVD? | Rheumatology | 01-2006
The association of increased cardiovascular morbidity and mortality with chronic inflammatory disorders such as rheumatoid arthritis has been known for some time. The use of CRP levels to help determine ...

Diabetic angioedema: preventing renal damage | Cardiology | 11-2005
The Canadian Diabetes Association has recently changed its guidelines for the treatment of type 2 diabetes. Cardiovascular disease is responsible for 60-75 of mortality in this population. Some experts feel ...

What occasions a retinal vein occlusion? | Ophthalmology | 11-2005
The development of a retinal vein occlusion in an older patient is most strongly related to atherosclerosis and glaucoma. In an individual of this age group, a workup should include ...

RAAS blockers: keeping K in check | Hematology | 10-2005
Patients who develop mild to moderate hyperkalemia amp amp 151 less than 5.8 mmol L amp amp 151 while receiving rennin angiotensin-aldosterone system RAAS blockers, either ACE inhibitors or ARBs, ...

Does subclinical hypothyroidism need treatment? | Endocrinology | 09-2005
If the TSH remains elevated over several months, I'd recommend treating with thyroid hormone replacement. Both the dyslipidemia and hypertension can improve, as might other metabolic factors as well. I'd ...

Effect of NSAIDs and COX-2s on BP | Nephrology | 09-2005
I'd try to avoid the use of both NSAIDs and COX-2 inhibitors unless strongly indicated, weighing the ratio of risk to benefit. If I had to use these agents, I'd ...

Is rebound reflux a result of PPIs? | Gastroenterology | 08-2005
Your question raises several interesting points. Although rebound hypersecretion can occur after stopping PPIs, the clinical relevance of this effect isn't known. In my practice, I haven't encountered it yet. ...

Evidence for ACEs and ARBs in non-diabetics | Nephrology | 08-2005
The renin-angiotensin system has been implicated in the progression of both diabetic and non-diabetic renal disease. ACEs with or without ARBs have been shown in randomized controlled trials to reduce ...

Count on stroke prevention | Hematology | 06-2005
I assume your question refers to anticoagulation in patients with atrial fibrillation AF . The likelihood of stroke in individuals with AF who don't receive warfarin varies greatly, depending on ...

What's up with hyperkalemia? | Nephrology | 06-2005
Some individuals with diabetes may have associated hyporeninemic hypoaldosteronism that results in hyperkalemic distal renal tubular acidosis, also known as RTA type IV. If this possibility hasn't already been excluded, ...

Confusion reigns over HOPE in EUROPA | CArdiology | 05-2005
Unfortunately, despite keeping up to date, I would consider the evidence from large clinical trials conflicting. My take-home message is to treat blood pressure aggressively, and for many patients, that ...

How are ASA doses deciphered? | Cardiology | 04-2005
A meta-analysis has clearly demonstrated that ASA significantly reduces the risk of coronary events by 28 . On the down side, ASA users had a non-significant trend towards increased risk ...

Is SARS tied to smoking? | Respirology | 04-2005
This hasn't been specifically studied yet. What has been shown to correlate with increased mortality is age over 60, diabetes or cardiovascular disease, and comorbid conditions including chronic obstructive pulmonary ...

Cold meds and contraindicated interactions | Respirology | 04-2005
Cold medicine consists of basically four types of drugs decongestants which often contain stimulants such as pseudoephedrine that can cause cardiovascular effects, antihistamines that may lead to drowsiness, cough suppressants ...

Rx for reactions to hypertension meds | Cardiology | 03-2005
You have many options here. I still consider diuretic therapy as first-line management of uncomplicated hypertension. For your patient, hydrochlorothiazide at 25 mg a day would be reasonable. Remember, however, ...

Does marijuana raise BP? | Cardiology | 03-2005
I'm not aware of the literature on marijuana and hypertension, but high blood pressure in young individuals is becoming more common, especially in those with central adiposity and the metabolic ...

What's behind hypertensive response to exercise? | Cardiology | 12-2004
The classic definition of hypertension is an office blood pressure BP reading greater than 140 90 mm Hg, measured on at least 3-5 occasions. This is a controversial area, however. ...

Are benzodiazepines safe with CPAP? | Respirology | 12-2004
The best treatment for sleep apnea -- a disorder that can lead to an increased incidence of sudden death, arrhythmias, hypertension, etc. -- is the CPAP mask. It often takes ...



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