Clinical Briefs in Primary Care – March 1, 2015
March 1, 2015
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Ambulatory BP Monitoring
The benefits of hypertension treatment (HTN), often cited as a 25% reduction in myocardial infarction, 40% reduction in stroke, and 50% reduction in heart failure, have generally been demonstrated in clinical trials based on an office blood pressure measurement. Since a substantial minority of patients enrolled in HTN trials — approximately one-third according to numerous estimates — ultimately turn out to have white coat HTN (wc-HTN), we may be underestimating the actual benefits of HTN treatment. Patients with wc-HTN do not suffer the same increased risk of cardiovascular events as HTN patients; hence, their inclusion in HTN trials “dilutes” treatment effects.
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A New Oral Treatment for Hyperkalemia: Patiromer
Patiromer (PAT) is an oral non-absorbable polymer that works by binding potassium (K+) in exchange for calcium in the distal colon. Currently available oral treatments for hyperkalemia are burdened by GI adverse effects as well as limited efficacy. Hyperkalemia is particularly problematic in chronic kidney disease (CKD), which may be compounded by the need to administer ACE inhibitors or angiotensin II receptor blockers (ARB).
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Obesity Leads to Overdiagnosis of Airflow Obstruction
Some commonplace disorders can readily misdirect clinicians about the presence of other important diagnoses. For instance, in patients with chronic obstructive pulmonary disease (COPD), deterioration of cardiac function, leading to congestive heart failure, can easily be misinterpreted as worsening COPD since fatigue, exercise, intolerance, and dyspnea are common to both. Could obesity misdirect clinicians in their diagnostic process for COPD? This report from the Veterans Administration system suggests that it can.
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Modifying the Home Environment to Prevent Falls
Falls in the home setting are a commonplace source of serious injury. In the recent past, most studies to address falls have addressed children, disabled persons, or the elderly. There is little information on more general populations, or whether a standardized set of environmental modifications — not designed to address any specific disability — would reduce falls and their consequences.
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Every-other-day Tadalafil for Lower Urinary Tract Symptoms and Erectile Dysfunction
Although the incidence of erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) both increase with age, there is an as-yet ill-explained independent association of LUTS with ED. That is, within each age decile, more severe LUTS is associated with more severe ED.
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Reassuring Safety Data about Incretins and CHF
The class of medications used to treat diabetes (and obesity) known as “the incretins” includes several DPP4 inhibitors and GLP1 agonists. These agents have achieved a favorable status in prescribing algorithms because of the combination of their low risk of hypoglycemia, impact upon weight (neutral for DPP4, weight loss for GLP1), and effects on postprandial glucose attributed to glucagon blunting.