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In the 61st episode, the seventh podcast in our thesis on type-2 diabetes, we get off the topic of glucose and talk about STENO and blood pressure treatments. We decide the bottom line is control of blood pressure with low doses of thiazides and ACE inhibitors with no tolerance for side effects. Mike’s blood pressure goes up with some of James’ suggestions but high doses of reserpine, methyldopa and clonidine calm him down.
Show Notes
1) STENO
N Engl J Med 2008;358:580-91
2) Blood pressure trials
UKPDS 38
BMJ 1998;317:703-13
HOT Trial
Lancet 1998;351:1755-62
Do ACEI/ARBs uniquely protect the kidney – No?
Lancet 2005;366:2026-33
ALLHAT
JAMA 2002;288:2981-97
Low doses of ACEI – most of the BP effect is from low doses
Cochrane Library
MICROHOPE
Lancet 2000;355:253-59
{ 2 comments… read them below or add one }
Hello everyone. As someone wrote some time ago, it’s my first comment, but I’ve been listening to the podcast for a few months now (and I always learn something!). Having finished med school only 4 years ago, lately I find myself questioning what I learned more often than I ever imagined. Are we really helping our patients or generating a greater sense of illness when we lower our targets? I found this Cochrane review, and since it’s not on the show notes (it was only published one month ago), I thought I’d share: Arguedas JA, Perez MI, Wright JM. Treatment blood pressure targets for hypertension. Cochrane Database Syst Rev 2009; 3:CD004349. In brief, there where no differences in mortality or morbidity when patients where treated to targets bellow the standard 140-160/90-100mmHg.
Daniel (Family Medicine Resident – Oeiras, Portugal)
Thanks Daniel – that was written by the excellent Cochrane review group linked with the Therapeutics Initiative here in Vancouver – I had seen it and it is on our list to discuss in our “new studies” podcast that we hope to do in the next month or two.
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