geoffrey modest medical blogs

  Hyperaldosteronism 2025 guidelines  Modest, Geoffrey (HMFP - Medicine) ​ Modest, Geoffrey (HMFP - Medicine) ​   a recent clinical practice guideline for primary aldosteronism was just published by the Endocrine Society: see  aldosteronism practice guideline JClinEndoMetab2025  in dropbox, or doi.org/10.1210/clinem/dgaf284). this is a 43 page document, so i will present their major recommendations applicable to the primary care outpatient setting, with my commentary (thanks to Ian Huntington for bringing this to my attention) Recommendations -- All patients with hypertension should be screened for primary aldosteronism (PA) by measuring aldosterone and renin levels, and determining the aldosterone-to-renin ratio     -- very little direct data supporting this (only one large retrospective VA study), finding that very few people were screened for PA (1.6%)         -- international studies in Canada, Australia and several E...

  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...