In episode 102, Mike and James, with laser precision, look at the evidence around blood pressure targets. We cover data in non-diabetics, diabetics, chronic kidney disease and the elderly. At the end they agree that the BP target we used 30 years ago (140/90) is still pretty good. To prove the point James gives Mike some sublingual nifedipine and Mike demonstrates the J-curve by falling on the floor and ‘pretending’ to be unable to get up (faker!).

Show notes
1) Systematic review of intensive BP treatment

Cochrane review CD004349

2) ACCORD blood pressure study
N Engl J Med 2010;362:1575-8

3) CARDIO-Sis
Lancet 2009;374:525–33

4) AASK – chronic kidney disease
N Engl J Med 2010;363:918-29

5) INVEST – retrospective data
JAMA 2010;304:61-68

6) BP guidelines
US
Curr Hypertens Rep 2010; 12:290–295
The Seventh Report of the Joint National Committee on: Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. August 2004
Canadian
2009 Canadian Hypertension Education Program Recommendations: The Scientific Summary
European
J Hypertension 2009, 27:2121–2158

7) BP in the elderly
N Engl J Med 2008;358:1887-98
Hypertens Res 2008;31:1595-601
Hypertension 2010;56:196-202

In episode 101, your friendly centurions, James and Mike, take a shot at the evidence around target doses for drugs in CHF and find the data is not as compelling as one might think. They discuss the approach of making sure we don’t cause side effects trying to get patients to these targets.  To prove the point, we both took high doses of ACE inhibitors, ARBs, and beta-blockers at the beginning of the podcast and the recording results clearly demonstrate the harm  that can occur from arbitrary use of high doses of medications.

Show notes

1) Getting to carvedilol doses

QJM 2004;97: 133-9

2) Network – ACE doses

Eur Heart J 1998;19:481-9

3) ATLAS – ACE doses

Circ 1999;100:2312-8

4) Carvedilol doses

Circulation 1996;94:2807-16

4) Beta-blocker doses

Ann Intern Med 2009;150:784-94

5) HEAAL – losartan

Lancet 2009;374;1840-8

Mike and James ‘celebrate’ their 100th episode by scouring the world for insightful commentary and therapeutic gems and bring them to you in a hodgepodge of a podcast. The bottom line – we wish to thank you for listening, we hope our rantings have improved your practice in some way and that you stick with us as we enter the next century of TEC podcasts.