Can you cure my blood pressure doctor?
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Can you cure my blood pressure doctor?
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I was asked this by a lady in clinic on Tuesday and by coincidence one of my old bosses has just published a study on detecting Conn's adenomas using PET-CT. http://www.cam.ac.uk/research/news/new-tes
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Forums » Open clinical » Cardiology » Can you cure my blood pressure doctor?
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Can you cure my blood pressure doctor?
posted at 2/12/2011 8:55 AM GMT
on bmj.com
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Posts: 877
First: 17/6/2011 Last: 23/5/2013 |
I was asked this by a lady in clinic on Tuesday and by coincidence one of my old bosses has just published a study on detecting Conn's adenomas using PET-CT. http://www.cam.ac.uk/research/news/new-test-could-help-thousands-of-patients-with-high-blood-pressure/ It looks like a nice application of imaging but I think the numbers of patients detected will be small and the test is best reserved for specialist clinics. i don't believe I have diagnosed a Conn's syndrome recently but perhaps this is because I don't look? Who screens routinely for Conn's and what's your pick up rate? |
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Re: Can you cure my blood pressure doctor?
posted at 8/12/2011 9:11 AM GMT
on bmj.com
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Posts: 877
First: 17/6/2011 Last: 23/5/2013 |
Perhaps I'm too pessimistic about curing blood pressure! You might want to look at the Symplicity HTN-2 trial in the Lancet which looks at renal sympathetic denervation ( reduces renin release as the presumed mechanism of action). In patients with systolics >160mmHg on 3 antihypertensives the technique reduced systolic BP by 32mmHg on average. I don't know of any fourth line agent that would do this! Do you think it will catch on? http://www.ncbi.nlm.nih.gov/pubmed/21093036 |
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Re: Can you cure my blood pressure doctor?
posted at 8/12/2011 3:26 PM GMT
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
Hello Sadian: "the technique reduced systolic BP by 32mmHg on average. I don't know of any fourth line agent that would do this! Do you think it will catch on?" I think you are a great optimistic person, not a pessimistic one!!! I have heard some critics that this population was not all that truly resistant hypertensives. Another article in an expanded population, using renal denervation, only a bit less than 25% were taking spironolactone - So, are they truly resistant hypertensive subjects??? I am not that optimistic with this method, but I will wait and see more data about it. All Best, Joey |
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Re: Can you cure my blood pressure doctor?
posted at 9/12/2011 8:31 AM GMT
on bmj.com
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Posts: 877
First: 17/6/2011 Last: 23/5/2013 |
Thanks both - I agree Joey R I live forever in optimism! I guess one person's defintion of resistant hypertension is another person's defintion of poor pharmaceutical management! It is an intriguing technique and we definitely need more data before we ablate everyone's kidneys! I think DuaneF raises an important point in a week where we have seen data published of the link between lifestyle factors and cancer risk perhaps we should focus more on empowering patients to take control of their adverse lifestyle factors before we reach for the prescription pad? |
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Re: Can you cure my blood pressure doctor?
posted at 9/12/2011 2:47 PM GMT
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
It is very easy adding drugs to hypertensive individuals. In my hypertension clinic, the truly resistant ones (Not controlled under full dose Chlortalidone, Calcium channel blockers and ACE-Inhibitors) are mostly overweight, obese, sedentary, have associated diabetes or metabolic syndrome. Spironolactone very usually adds a measurable blood pressure drop. But, people need to loose weight and get a healthier lifestyle, otherwise they will be forever slaves of multiple anti-hypertensive drugs. Those who loose weight and get healthier lives (and they indeed exist) have a quite impressive blood pressure effect! This "simple" renal denervation technique seems too good to be true. But, I sincerely hope to be wrong. In parallel with the achievement of more and unbiased data, a lot of catheters and procedures are being sold. All Best, Joey
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Re: Can you cure my blood pressure doctor?
posted at 12/12/2011 12:09 PM GMT
on bmj.com
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Posts: 877
First: 17/6/2011 Last: 23/5/2013 |
The National Institute of Clinical Excellence in the UK are looking at renal denvervation. You can see their recommendations here http://www.bcs.com/images/news/Joint%20UK%20Societies%20consensus%20statement%20on%20renal%20denervation.pdf Joey R do you think this is recommendation fits in the correct point in terms of drug therapy? best sadian |
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Re: Can you cure my blood pressure doctor?
posted at 12/12/2011 12:47 PM GMT
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
Hello Sadian: Yes, NICE gave a good recommendation: 1. ABPM for all with suspected resistant Hypertension. 2. Resistant Hypertension also on Spironolactone (Step 4 - NICE guidelines for Hypertension Treatment). 3. Emphasis on previous full-try of Lifestyle modifications. These criteria did not seem to have been met in the previous SIMPLICITY trials. So let´s see now how this method will work, for real and in the long-term. All Best, Joey
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Re: Can you cure my blood pressure doctor?
posted at 16/12/2011 10:30 PM GMT
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
Hello Sadian: I should come soon to a special meeting in Frankfurt all about this Renal Denervation technique. I would like to publicly dedicate my presence there to your enthusiasm for this technique! All Best, Joey
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Re: Can you cure my blood pressure doctor?
posted at 22/12/2011 5:20 PM GMT
on bmj.com
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Posts: 877
First: 17/6/2011 Last: 23/5/2013 |
Please update us Joey R as to the outcome of the meeting and it will be good to hear what you think. Sometimes we embrace new technology without really evaluating the evidence and it will be good to hear what you think given your very broad knowledge of hypertension. |
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