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Yearly Archives: 2015

The Value of the Nitric Oxide Pathway and its Importance in African-American Patients with Heart Failure

Talking to Patients

Studies in heart failure and hypertension have shown that people who identify themselves as black may have a less active renin-angiotensin system and a lower bioavailability of nitric oxide. The A-HeFT study was conducted to determine if a fixed dose of isosorbide dinitrate (ISDN) and hydralazine would provide additional benefit in black patients with heart failure.

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Editor’s Note – DCMS-258

I was reading this week’s Clinical Gem about the use of diuretics for reducing heart failure and blood pressure values. There was a mention of the differences in responses among certain ethnic groups and the difficulty that we often have with African-American patients. There was a lot of focus on …

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Practical Diabetes Care, 3rd Ed., Excerpt #30: Hypertension Part 5 of 5


David Levy, MD, FRCP Diuretics Thiazide diuretics have been the mainstay of antihypertensive treatment since the first potent thiazide was introduced in 1957, and have often been the agents against which other drug classes have been compared in important clinical trials [18]. They are especially useful in low-renin (salt-sensitive) states, for example older people, and black or obese patients. Resistant hypertension (see below), common in these groups, is frequently due to inadequate diuretic therapy. Despite half a century of use, disagreement continues about their optimum dosing and whether blood pressure lowering effects and cardiovascular benefits are common to all agents in the class. There is continuing controversy about their potential metabolic disadvantages – concern about these, together with their low pharmaceutical profile, prevents their being used in many patients – but there is no evidence that these in any way blunt their cardiovascular benefits, even in people with diabetes (Box 11.7). They are as effective in reducing coronary events as any other class of antihypertensive agents, but in ALLHAT were more effective in reducing heart failure and stroke than lisinopril or amlodipine...

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