A Fresh Approach to Understanding Clinical Hypertension

With advances in the field of nephrology broadening our knowledge of transplant medicine, glomerular disease, and the interventional aspects of access, I believe fellowship training in the traditional areas of the specialty such as hypertension have diminished.

And yet, apart antibiotics, anti-hypertensives are the single most important therapy contributing to rising life expectancies. Because while ESRD trials focus on endpoints such as PTH levels and the CKD literature uses outcomes such as a doubling of serum creatinine, hypertension studies utilize clinical endpoints such as all cause mortality.  Moreover, it’s a fascinating disease, our understanding of which is unrivaled by any other condition. What is the circadian rhythm of blood pressure? How does pulse pressure affect the risk of CAD? What is the relationship between basal heart rate and mortality? To understand hypertension is to appreciate human physiology, to apply evidence-based medicine, and to practice cost effective care. Moreover, despite the proliferation of national treatment guidelines, management is more nuanced than targeting similar blood pressure levels for all patients and prescribing the same handful of agents. The “art” of management hinges on understanding the difference between metoprolol and betaxolol, hydrochlorthiazide and indapamide, and losartan and azilsartan. As such, if there is one disease to know, and know well it’s hypertension.

To improve my own knowledge of the above, I’m currently undertaking an additional fellowship in hypertension under George Bakris at the hypertension center here at the University of Chicago. In order to share what I have learned, I’ve created a bi-weekly e-newsletter, “Concepts in Hypertension,” as a non-commercial medium to convey key aspects of the disease. Each issue is concise, summarizing one seminal paper and underscoring one key concept. The newsletter then ends with a “clinical perspective” that indicates how the selected paper informs the management of patients at our hypertension center.

Below are several recent issues. If you’d like to subscribe to this free, non-commercial publication, you can do so by visiting www.bp-specialists.com/newsletter

Rethinking HCTZ as your diuretic of choice

The Circadian Rhythm of BP: Why AM BP control is critical

Low Dose Combination Therapy: Why less is more

Pulse Pressure-What it is and why it matters

Hillel Sternlicht

The University of Chicago