Tag Archives: hypertension

A Brief History of the Renin-Angiotensin System

If you’re here for the music you still might give this piece a glance. It’s on a subject of immense clinical importance that I’ve tried to present in a fashion accessible to layman while still having some content that might interest physicians. Some of the greatest work in medical pathophysiology has contributed to our current…


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The Salinity Obsession

Many physicians and those charged with regulating the nation’s health have been obsessed with salt since Lot’s wife was transformed into a pillar of the stuff. On March 7, 2018  the JAMA published online a well performed study of sodium intake, the investigators used 24 hour urinary sodium excretion as a marker of intake, which documents…


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Salt Intake in Chronic Kidney Diease

How much salt people should eat continues to be a murky issue. A paper in the February 2017 issue of the American Journal of Kidney Diseases examines the issue of salt (actually sodium) intake on the prevention of cardiovascular disease in patients with chronic kidney diseases (CKD) stages 2-4. It is a commentary on an…


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Salt and More Salt

The August 14, 2014 issue of the New England Journal of Medicine contains three papers on salt intake and health. The third of these is so layered with assumptions that I won’t discuss it. I have previously written about recommendations for optimum dietary intake of salt. In 2011 the American Society of Nephrology endorsed guidelines…


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More on Diabetes and Tight Blood Pressure Control

In May I commented on a study in the New England Journal of Medicine that failed to show a benefit in lowering systolic blood pressure below 130 mm Hg. Well, now there’s another such study. This one is in the Journal of the American Medical Association. “Patients were categorized into 3 groups by their average…


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Diabetes and Blood Pressure Control

It’s been standard clinical practice for some time to aim for a lower blood pressure in diabetic patients with hypertension compared to hypertensive patients with normal glucose metabolism. Like so much in medicine this approach was based on surmise rather than evidence. The thinking went along these lines. Diabetics are at greatly increased risk for…


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Dietary Salt Reduction and Cardiovascular Disease

A paper in the New England Journal of Medicine, Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease, concludes that “Modest reductions in dietary salt could substantially reduce cardiovascular events and medical costs and should be a public health target.” This conclusion is based on the use of a very complicated computer model of…


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Hypertension in the Very Old

Virtually all physicians treat their hypertensive patients who are 80 years old or more. The evidence for the effectiveness of this treatment in very old patients has up till now been lacking. The New England Journal of Medicine has published a paper, Treatment of Hypertension in Patients 80 Years of Age or Older, that shows…


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