By Massimo Salvetti (auth.)
This ebook is designed to help physicians within the daily administration of hypertensive sufferers, with a specific specialize in difficult-to-treat and resistant high blood pressure. the chosen medical situations are consultant of the sufferers who're noticeable within the “real world”, instead of infrequent medical instances, and supply examples of administration based on present foreign directions. The eventualities thought of contain not just instances during which arterial high blood pressure is actually resistant but additionally circumstances of pseudo-resistant high blood pressure, together with instances during which resistance is said to comorbidities, concomitant remedies, or using medicinal drugs. the last word target is to supply paradigmatic examples of evidence-based techniques to difficult-to-treat sufferers that might aid physicians to pick the main acceptable diagnostic instruments and evidence-based remedy method for every person patient.
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Additional resources for Resistant Hypertension
He smokes 2–4 cigarettes per day. He is taking regularly his medicines and appreciates the reduced burden of pills. 1 kg/m2 Resting pulse: regular rhythm with 72 beats/min Other parameters substantially unchanged No ankle oedema Blood Pressure Profile • Home BP (average values during the last week, daily measurements in the morning and evening): 134/80 mmHg (early morning) • Sitting BP in the office: 138/86 mmHg (mean of three measurements, in sitting position) • Heart rate 72 bpm • Standing BP: 138/92 mmHg 48 Clinical Case 3.
2008;93(9):3266–81. 6. Roush GC, Ernst ME, Kostis JB, Tandon S, Sica DA. Headto-head comparisons of hydrochlorothiazide with indapamide and chlorthalidone: antihypertensive and metabolic effects. Hypertension. 2015;65(5):1041–6. 7. Chapman N, Dobson J, Wilson S, et al. Effect of spironolactone on blood pressure in subjects with resistant hypertension. Hypertension. 2007;49:839–45. 8. Williams B, MacDonald TM, Morant S, Webb DJ, Sever P, McInnes G, Ford I, Cruickshank JK, Caulfield MJ, Salsbury J, Mackenzie I, Padmanabhan S, Brown MJ, British Hypertension Society’s PATHWAY Studies Group.
4 Follow-Up (Visit 3, Final Visit) at 1 Month The patient is in good clinical conditions. She is maintaining a healthy lifestyle, she does not eat liquorice candies, but she is still smoking ten cigarettes per day. 4 Follow-Up (Visit 3, Final Visit) at 1 Month 31 Blood Pressure Profile • Home BP (average): 90/68 mmHg • Sitting BP: 94/72 mmHg • Standing BP: 92/78 mmHg 12-Lead Electrocardiogram Not performed (not appropriate). Current Treatment • No treatment Treatment Evaluation ✓ No treatment Prescriptions ✓ Smoking cessation ✓ Regular physical activity ✓ Healthy diet Diagnosis A final diagnosis was made: – Severe (grade 3), transient, treatment-resistant hypertension, secondary to ingestion of large doses of liquorice – Complete resolution of the hypertensive state after withdrawal of liquorice – Primary hypothyroidism due to Hashimoto’s thyroiditis 32 Clinical Case 2.
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