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Very low LDL levels: benefit without harm

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resistant hypertension: are diuretics harmful?

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  i decided to comment extensively on a very recent review article that supports the quite provocative argument that we are treating hypertension incorrectly, especially treatment-resistant hypertension, and that we should avoid the early use of the typical diuretics and instead use spironolactone much earlier in the cascade of meds. this pretty brief article is well-referenced (59 references) to support each of their points and to justify their proposed paradigm-shift in hypertension treatment (see   htn resistant diuretics harmful HTN2025  in dropbox, or . DOI: 10.1161/HYPERTENSIONAHA.125.24871): -- treatment-resistant hypertension (TRH) has historically been defined as the failure to achieve the recommended blood pressure with at least 3 classes of antihypertensive meds, including a diuretic, at target or maximally tolerated doses     -- in general, the diuretics used are thiazides or chlorthalidone unless there is significant renal failure, when loop di...
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UPDATE: ASCVD risk factor critique

I decided to do an extensive update of my prior ASCVD (atherosclerotic cardiovascular disease) risk analysis and critique of risk calculators, with much more information about the “non-traditional” risk factors. I felt that there should be more data/clarification, since I think we are really undertreating/not preventing the most common cause of death by relying on the current ASCVD risk calculators   -- Cardiovascular risk models:      -- many of us rely on the various cardiovascular risk models to determine the appropriate approach to patients, and these are often integrated into the electronic medical records      -- these risk models have several very important limitations:          -- they are typically based on community data, eg from the Framingham study etc. But, in clinical practice, we are dealing with the individual and not the community:          ...
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