geoffrey modest medical blogs

  A large Chinese trial found that using salt substitutes with a high potassium level not only lowered blood pressure but decreased the risk of stroke, major cardiovascular events, and death from any cause, in the Salt Substitute and Stroke Study (SSaSS): see  htn salt substitute china nejm2021   in dropbox, orDOI: 10.1056/NEJMoa2111437   Details :  -- 20,995 people were involved in an open-label, cluster-randomized trial from 600 villages in rural China, with the goals of recruiting approximately 35 persons from each village and to follow them for five years  -- all had a history of stroke or were >60yo and had hypertension, the latter defined as systolic blood pressure >140 mmHg if on blood pressure lowering medication or >160  mmHg  if not -- exclusion criteria included known serious kidney disease, use of a potassium sparing diuretic, or use of a potassium supplement -- mean age 65 years, 50% female, 73% history of stroke, 88% history of hypertension  -- mean blood pressur

  A recent real-world effectiveness study compared ACE-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) in the treatment of hypertension, suggesting that ARBs should be the first choice given their better safety profile, and that we should not have an equipoise approach of either being equally appropriate (See  htn ARB over ACE htn2021  in dropbox, or  DOI: 10.1161/HYPERTENSIONAHA.120.16667 ). Thanks to Jon Pincus for bringing this to my attention    Details:  -- retrospective, new-user comparative cohort design study using statistical techniques to  minimize confounding:     -- a few different approaches to propensity scoring to match the groups, involving tens of thousands of measured baseline covariates, including demographics, diagnoses, drug exposures, drug groups, procedures, comorbidities, risk scores     -- including 76 negative control outcomes (these are outcomes that should not be associated with any of these medications but should help reveal the extent of the pl