geoffrey modest medical blogs

  A recent systematic review and individual participant-level meta-analysis of clinical trials found that prescribing ACE-inhibitors or ARBs to patients with advanced chronic kidney disease (stage 4 or 5) was beneficial: see ckd ACE ARB good for advanced CKD AnnIntMed2024 in dropbox or doi:10.7326/M23-3236)   Details : -- 18 completed randomized controlled trials were found in a literature search from 1946 to 2024 -- 1739 participants were included, mean age 55, 52% female, 15% Black -- median eGFR by creatinine was 23 (IQR 18-27), 32% had eGFR below 20; median albumin-creatinine ratio 1215mg/g (range 527-2463 mg/g) but 84% had “severe albuminuria” (which they did not define, >1000mg???) -- mean systolic BP 155 mmHg -- the issue of determining the overall demographics/comorbidities/etc is difficult given the huge differences in the individual studies, including year study done (varies from 1992 to 2007), different meds used (perindopril-ind...

  hypertension: a personalized approach to meds      You forwarded this message on Mon 5/1/2023 6:33 AM You forwarded this message on Mon 5/1/2023 6:33 AM MG Modest, Geoffrey (HMFP - Medicine)      To:  Modest, Geoffrey (HMFP - Medicine) Mon 5/1/2023 6:32 AM   A very interesting Swedish study just came out suggesting that we should approach hypertension treatment in an individualized way (see  htn variability of response to meds JAMA2022  in dropbox, or  doi:10.1001/jama.2023.3322)    Details :  -- 270 participants in an outpatient research clinic in Uppsala Hospital who were 40-75yo and had systolic blood pressure (SBP) between 140 and 159 mmHg and diastolic < 109 mmHg within five years before the trial,  were randomized in a double-blind repeated crossover trial . All were at low cardiovascular risk   -- 46% female, median age 64, BMI 29, BP at randomization 154/89, ambulatory daytime BP 145/89 -- median of 3 years since ...