martedì 8 aprile 2008

Ipertensione resistente al trattamento

Questo articolo pubblicato sull'ultimo numero di Hypertension esamina in modo dettagliato ma sintetico l'approccio al problema dell'ipertensione arteriosa resistente al trattamento farmacologico. Dagli errori nella misurazione alle cause di ipertensione secondaria ai suggerimenti per le migliori associazioni farmacologiche.

Resistant Hypertension: AHA Committee Offers Recommendations

A committee of the American Heart Association has issued a review of resistant hypertension in the journal Hypertension.

The committee advises:

-- care in the technique of taking blood pressure, which can itself lead to errant diagnoses;
-- ruling out the "white-coat effect" by use of ambulatory monitoring, if necessary;
-- looking for secondary causes of hypertension, such as obstructive sleep apnea, renal artery stenosis, and primary aldosteronism;
-- encouraging weight loss, moderation in drinking, and salt restriction;
-- maximizing diuretic therapy, while considering the addition of a mineralocorticoid receptor antagonist;
-- combining agents with different mechanisms of action, such as an ACE inhibitor and a calcium channel blocker.

The article includes a simple, helpful chart that outlines diagnostic and treatment recommendations.

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