A new review article on resistant hypertension, which affects about 1 in 10 people with high blood pressure, is aimed at helping physicians assess and manage patients with the condition. The review, published in CMAJ (Canadian Medical Association Journal) includes information on emerging therapies for the condition.
About 20% of Canadian adults have hypertension (high blood pressure.) Resistant hypertension is defined as blood pressure levels that exceed the target level despite treatment with three or more hypertension drugs. Obesity, especially a large waist circumference, and sleep apnea are the top contributing factors to resistant hypertension. Patients with resistant hypertension are at higher risk of heart disease and death.
The authors note that high-quality evidence is lacking. “We found few randomized controlled trials (RCTs) and no systematic reviews to guide decision-making. Thus, we have made management recommendations based primarily on expert consensus unless otherwise specified,” writes Dr. Raj Padwal, Department of Medicine, University of Alberta, with coauthors.
Before treating patients for resistant hypertension, physicians must rule out “pseudoresistance.” Elevated blood pressure during physician visits (“white coat effect”), not taking recommended medications and inaccurate blood pressure measurements can contribute to apparently resistant hypertension.
The review recommends structured approaches to managing this condition:
- optimizing current medication regimen and strategies to improve adherence
- counselling patients to reduce salt intake, limit alcohol, exercise and strive for a healthy weight
- treating obstructive sleep apnea with continuous positive airway pressure
- adding drugs when current drugs are not effective — spironolactone, a-blockers, b-blockers and others
- referring patients to clinics with hypertension specialists
The authors close by emphasizing the need for more rigorous studies in the field to address knowledge gaps and clarify uncertainties.
Media contact for interviews:
Ross Neitz, Communications Associate, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, tel: 780-492-4616, firstname.lastname@example.org for Dr. Raj Padwal
We need to improve dental health of Canada’s seniors Editorial
Many seniors in Canada have poor oral health, and we need to start the conversation about how to improve access to dental care for this vulnerable group, argues an editorial published in CMAJ (Canadian Medical Association Journal).
Poor dental health is linked to serious health conditions such as heart disease, stroke and pneumonia and can affect quality of life.
“Most seniors in Canada do not have coverage for dental care, apart from specific oral surgery procedures that are performed in hospital,” write Dr. Diane Kelsall, Deputy Editor, CMAJ, and Dr. John O’Keefe, Canadian Dental Association. “This lack of coverage has serious health implications for older Canadians, which puts this vulnerable group at higher risk for both dental and systemic disease.”
Difficulty brushing and flossing because of mobility issues, medications that can affect production of saliva, and chronic diseases that lower immunity contribute to poor dental health in seniors. More than half of older adults have no dental coverage because most lose coverage upon retirement; more than 1 in 10 seniors avoid dentists, and about 1 in 6 refuse dental treatment because of the high cost.
Only Alberta and the Yukon Territory provide dental coverage for people over age 65.
“The consequences of poor oral health extend far beyond the mouth,” write the authors. “With our ageing population, the burden of illness associated with oral and related diseases can increase health care and socioeconomic expenditures across the system.”
“We hope this dialogue will create a roadmap that will lead to tangible positive oral health outcomes for seniors.”
Media Contacts for Editorial:
Kevin Desjardins, Director, Public Affairs, Canadian Dental Association, tel: 613-898-8248 (mobile), 613-520-5035 (direct),email@example.com
Kim Barnhardt, Communications, CMAJ, tel: 613-520-7116 x2224, firstname.lastname@example.org, for Dr. Diane Kelsall
Raj S. Padwal MD MSc, Simon Rabkin MD, Nadia Khan. Assessment and management of resistant hypertension. CMAJ 2014. DOI:10.1503/cmaj.130764
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