17 Burst results for "Resistant Hypertension"
"resistant hypertension" Discussed on iForumRx.org
"Access were excluded. Non white participants were also underrepresented. I strongly agree with those criticisms and insights on this particular study and just want expound on a few of them. This study was conducted in the united states. But i think it actually does provide good evidence to pharmacists clinical pharmacists in the united states. Who may want to implement similar type programs. I am concerned that ninety four percent were british white patients which really does not represent many of our patient populations but a few things i want highlight is the goal values that were used and in britain they did use higher goal pressure values than we use the united states particularly in older patients. They used quite high goals. The reason i think that's relevant to consider is that there was a difference in results. In the younger cohort versus the older cohort in it did appear that younger patients that we're using the standard blood pressure goal which was the lowest one used in the uk actually had benefit where the older population especially those using that high blood pressure goal that i do not advocate for all that they did not benefit so perhaps the best use of these data may be in your younger population who have lower blood pressure goals executing as was mentioned resistant hypertension which would be really tempting to use this methodology but this really was targeting so that average hypertensive patient on one two three medicines which i think those frame framer population a little bit differently. Another thing that i think was very interesting. Was the power of the patient communication with the health professional. There was a perception of patients in intervention. group that a were perhaps healthier because they reported that they lost more weight though the numeric data did not support a difference patients perceived that they did. And i think that's a global market that perhaps patients may have some enthusiasm for the additional interaction with a health professional. I also have to say that they didn't use clinical pharmacists. In this study and i would have liked to have seen that so. What are the implications for pharmacy practice. I think some pharmacists and indeed some physicians nurse practitioners might see this kind of technology is threatening the idea that.
"resistant hypertension" Discussed on Cardionerds
"Five or more medicines including Tone and included down and those patients are a little bit different in that they tend to be in in some of the data. They tend to be driven more by excess sympathetic whereas resistant. Hypertension we know is oftentimes driven by access volume sodium retention etc. So important to to understand that first and foremost in mister peres here when you are diagnosing hypertension really important to think about excluding pseudo resistant hypertension. So make sure. He's taking his meds. Okay make sure he does get out of office blood pressure monitoring in that. We're not just catching him with some white coat hypertension. That's going to be really important. Make sure we've maximized his doses. Because if you're telling me he's on twelve and a half clarify clarifies twenty-five alot certain and two and half of them loaded team. Obviously we're not doing what needs to do from that perspective. And that's not going to be resistant hypertension. So thinking about those things is going to be really important and then they have to be doing the lifestyle things as well okay. The guy eating six grams of salt beer burgers etc yet. We're not gonna get controlled doesn't necessarily mean meaning to formally classify as resistant hypertension just need to get him on the better track. So how. how do we treat these folks. Let's say he's on twenty five dollars down. He's on eighty of thomas arden his on ten and his blood pressure still elevated. He says doc. I'm really good with taking my medication. New monitors out of office blood pressure with twenty four hour. Ab pm and then he's followed up with some home blood pressure monitor self looked pressure monitoring. And that's still elevated. Well then we can classify as resistant hypertension and it actually really good randomized control trial data for its treatment. And that's the use of spinal actum in this comes from. I believe it's two thousand fifteen in the lancet is the pathway to trial on what it was looking as comparing fourth line therapy for uncontrolled hypertension so is frontal actum that they they got doc season or placebo and charleston was clearly better than all of those medications when they when they saw. And there's a really nice graph in showing that it's really across the spectrum of the vast majority of Sarah marina levels k. So those patients that had lower reenen tended to do a little bit better in terms of blood pressure lowering but still even at higher levels of rain and they had more impactful blood pressure lowering with frontal count than the soper lawler boxes. So that's why it's in the h. As scientific statement unresistant hypertension. And that's why it's really emphasized in there as well as your fourth line or go to therapy. Now you have to be aware. The patient with hyper killing yet. Chronic kidney disease. We gotta be aware of that. But that's the nice thing about some of these potassium binders that..
"resistant hypertension" Discussed on Cardionerds
"You're going to just get the patient of big bill as not going to be worthwhile. Everyone always thinks that they're going to diagnose feel chroma saitama or paraguay allman. It never comes back like that now. It's not that we don't see it we do. It's just that these patients presenting with sales of elevated blood pressure or blood pressure liability typically. Don't have it so that's important. It's fine to send off the testing but really the results when you get them back. They're not they're not subtle. Okay if you're actually going diagnose it. In a lot of times. We can see mildly increased at an effort norman an effort given in just hypertensive individuals. Got your laundry list of other things that people typically check for hyper cortisol ism patient looks cushing roy. That would be something to look at it. Check at t s h. It's reasonable particularly resistant. Hypertension hypo hyper. Thyroid can lead to those changes. Grab you've mentioned a case of Court tation likely. They're just take some imaging. That would be a young patient with hypertension that we would look for. And then we we think about congenital hyperplasia primary hyperthyroidism very rare mineralogy quarter excess syndromes other than primary. Last ism so those would present with a typically low australian rain and they akra magli. Those are really the major categorisations of them. The one thing. I want people to take away from this. Podcast is send more although raanan reenen levels and savoring and right to but send more of them. Because you're going to pick up when you actually look for it. That's awesome daca laughing. I really is such a phenomenal review in chock full of pearls definitely taking away the pronunciation for reenen as well and i had my fair share of launching into is thorough secondary hypertension workup only to fall short. Really just diagnosing a patient with primary hypertension. This is important for next patient. Tom perez is a fifty eight year old man with a long standing history of hypertension at gird. Blood pressure in clinic is one fifty two over ninety two. Despite being on three eight his clinic blood tracks with his home blood pressure diary and evaluations for secondary causes were revealing in the past. He's usually quite religious with his medications. But does sometime have trouble remembering bicknell so with this mind. Dark laffin treat resistant hypertension. And what is your approach in these challenging scenarios here. That's a good question. And this is a patient that might show. We all can relate to others a few issues going on so really. The crux of it is water. Resistant hypertension because important. Understand what that definition is. That's a patient. That's taking a three or more blood pressure. Medicines typically fi a diuretic appropriately dose for kidney function a-block the ninja tencent system and then i had appeared in calcium channel blocker and then they're not at their goal blood pressure. That's typically what we think about with the definition of resistant hypertension and you can have controlled resistant hypertension. And so that means you're on those medicines plus another one and your blood pressure's controlled so that's the definition under the umbrella of resistant hypertension often times to point to that. There's a increasingly push over the last ten years or so a group down at uab has really made more of a push to define subset of those patients as refractory hypertension. So we don't wanna be using resistant refractory. Hypertension it's anonymously and they defined refractory hypertension is patients with uncontrolled blood pressure on.
"resistant hypertension" Discussed on Cardionerds
"How do you approach the choice of initial blood pressure. Medication in general. And what would be your top choices for this patient in particular so You know looking at his overall picture suggests that he's at a high risk for cardiovascular. Disease is still primary prevention patient but but pressures are elevated in the clinic and he's got a lot of risk factors. He's got past three c. K. d. he's got known diabetes sleep apnea obesity. So the american guidelines recommend typically in these folks that are in that stage to hyper-tension ranges. Everyone gets the lifestyle that we talked about. But then what we want to be. Starting with is fixed. Dose combination therapy. And so when you're when you're have lower blood. Pressure's it's reasonable to start with single agent therapy. Interestingly the european guidelines really unless there's overwhelming circumstances were worried about side effects really push fixed combination therapy as the first thing that you add in american guidelines. They give you a little bit of leeway so if you're twenty over ten above where we need to be then we should be starting fixed dose combination therapy and these folks in this guy. I definitely would start fixed us combination therapy right off the bat now. There's a few factors that we have to take into consideration here. The accomplish trial published back in. I believe it was two thousand eight looked at combination of a ac a statistic and so we know in that trial acc be tend to do a little bit better in terms of cardiovascular events but a couple things and keep in. Mind here one. He's african american gentlemen. Just in general to african americans tend to have more of a low green and hypertension so have a little bit less efficacy with ace inhibitors. Entry attention receptor blockers in the absence of a diuretic. So those medications work but we gotta get people on a diabetic so for someone like him. We'd probably go with combination. Enter tencent receptor blocker and fis type. Diuretic would be the best choice for him and typically affixed dose combination pill. Now the one problem with that when we think about it is a lot of the fixed dose combination pills. Don't come with a real good design tech. They come with hydrochlorothiazide and they don't come with napa my salad really. The most significant fixed those combination that comes with valid on is still brand name. It's asil certain and so it will be a good choice when it comes off patent but it's really unaffordable for most patients. And if you can't do that then what i would ultimately recommend in this gentleman is thinking about something like cloth or dabba might for his. I type diabetic particularly with his. Ckd because we know a lot of resistant hypertension is driven especially in kidney disease by volume. We know that at lower fires we're going to see a little bit less efficacy of hydrochlorothiazide. Then i would add on an ngo tencent. Receptor blocker can got a little bit of kidney protective effects without lower. Gfr i probably screen them for albumin. Urea as well because that can impact some of our choices in terms of blood pressure. Medications about really are cutoffs. Typically if are under forty five. I won't use hydrochloride. I don't use it very much anyway. But i i will more go with clark alanon. It has a more consistent affect all the way down to. Gfr thirty once we get into those. The stage four chronic kidney disease. Then you really looking at either sequential nefer on blockade. So if i type anna loop diuretic which can have a good blood pressure lowering effects particularly resistant hypertension but in your primary hypertension which we don't know if this guy's resistant pretension because we don't i don't have any medicine right now but we'd probably think about just their clark owner that might and if you were under thirty for gfr so stage four chronic kidney disease. Then we'd be thinking about adding a loop diuretic as well if he were caucasian than i probably be more likely to go with a die..
"resistant hypertension" Discussed on Cardionerds
"For at least one hundred fifty minutes of moderate intensity physical activity a week and that's consistent with the physical activity guidelines. I think they released most recently in two thousand nineteen weight. Loss in one kilogram is equal to about a millimeter of mercury in terms of blood pressure. Lowering that's a general rule of thumb obviously is going to be different for different people but understanding that's the case stopping smoking not drinking to excess the guidelines. Really say more than one drink in a woman per day is tends to raise blood pressure more than two drinks in a man per day. Ten th raise blood pressure we wanna get below that threshold coffee. Although it's not as well delineated in the guidelines we think about really no more than one to two cups a day in particularly in these individuals. And then the one thing. That's not really discussed much in that. The two thousand seventeen american blood pressure guidelines but is more prevalent in the resistant. Hypertension scientific statement published by the american heart association. Back in twenty eighteen was the of sleep on blood pressure. In how how important it is in terms of managing blood pressure. And we're really not talking just about obstructive sleep apnea because yes obstructive sleep apnea has been shown to be associated with resistant. Hypertension there's high prevalence amongst resistant hypertensive. But it's also even in the absence of sleep apnea. We really need to focus on quality and quantity of sleep and so what we have to aim for patients to get is between six to eight hours of uninterrupted sleep otherwise he tend to have excess sympathetic activity increased activity of the reenen ngos tencent system and ultimately more elevated blood pressures and this manifest in a variety of ways on speak with the fellows always being in this sheet of paper where a patient had their blood pressures written down and they had their hours of sleep written down on that third column next to it and it's very clear delineation to sleep six seven seven. Then oh four three. And then you'd see the next day heart rate was normally in the mid sixty s at all the way up into the eighties bloodpressure subsequently was up there as well so asking at least asleep history can also be really important in these individuals for non pharmacological treatment of blood pressure. I did a. I did a podcast for cleveland clinic. They like to do marketing stuff and talked about this. And i told them i said we. How are we going to get people to watch this. So we named it natural ways to lower your blood pressure and guess what in less than a year. It's got over six hundred thousand views. I looked at the comments. I'm not that bold. But no on you know i think most people think natural and they think some powder some special thing that they can buy on the internet but you and then i went through this list with it and people wanna hear this so at least if you're showing them that you can try this this this lifestyle things afford jump into the prescription pad. I think you gain a lot of credibility with the patients. They know that you care about them. You want them to not just be that person that writes the prescription. Those are really what i see as the most important lifestyle components of blood pressure in.
"resistant hypertension" Discussed on Cardionerds
"There was definitely news to me owen. Hey dan just walked into the clinic. Luckily dan is an intervention fellow and was just catholic one of our patients but he really wanted to make sure that he got an episode to learn from you. Because we've been thinking about this for so long doctor laughing. I m so those are late. I came as soon as i can. But for me beverly never because i definitely don't want to miss an opportunity to listen to some serious hypertension knowledge bombs from you. You're such an expert in this field than just. I couldn't miss out so sorry major fomo but here i am. That's great. you'll probably be more interested in when we talk about interventional stuff at the end. So there you go. No no intervention is really really fun. But i definitely want to know more about hypertension. This is incredibly important to know this. Okay so let me pick up where greg left off with miss bologna's horace. Her blood pressure is one thirty. Five over eighty five and her predicted tenure. Asc dvd risk or by old cohort is two point. Nine percent say we confirm that she is stage. One hypertension. I have two questions to pose to you number one. What lifestyle recommendations do you advise for. Blood pressure control specifically and two. Is it time to start medical therapy. Should we take the plunge and order some pills great. So i'll answer question number two for he. I is no not quite at this point. That gets back to this idea. The threshold of risk where we think where we should be starting medications and that's essentially a ten percent risk based on that that twenty seventeen american guidelines stage. One hypertension really. What we recommend is a lifestyle modification for blood pressure control in. That's really the crux of when you're talking about dealing with any type right pretension primary hypertension on one drug. All the way up to resistant. Hypertension what i typically tell. Patients is blood pressure. Control is seventy percent lifestyle thirty.
"resistant hypertension" Discussed on MAD MONEY W/ JIM CRAMER
"The pandemic shut everything down and March. There was a widespread sense that the medical device companies they could be in real trouble with hospitals. Over to lay non emergency procedures to focus on coded well, you had to worry that the whole industry might take it even Quill Harriet, heart the brain but now it's looking like the thesis was overblown take medtronic the best of breed medical device maker when these report, the most recent results near the end of August numbers came in far for better than expected after plumbing from one hundred and twenty to seventy two when Copen I hit the socks made its way back up to one zero seven. So giving keep burning, let's check him with Jeff the new CEO medtronic's not a stranger. Who held his first investor day is the top job Mr Moore welcome to mad money. Thank you Jim. Great. To be here well, I, I want to congratulate you your company's has gone through a very tough. Period for all device makers from Jay Jay, the other day I'm curious to know you had a very, very high level messages today about disrupting industries, accelerating growth. How are you going to do it? Well, we've got a lot of it. Well, first of all, we have the best pipeline in our company's history right now and we're product are launching today product. We're watching in the next couple of months, and then we have a whole second wave of innovation coming. So first of all Gimeno your real interested in our deep brain stimulation biggest, we just recently launched the latest version of our deep brain stimulation technology and includes a very unique feature. The ability to sense brain signals and sensing grain signals is really the key to optimizing certain neurological. Therapies like deep brain stimulation for Parkinson's and and this is not easy to do, and we're the only ones that can do this and it really it sets us up for like what we call close loop therapy which really amounts to personalize therapy. So we can listen to the signals in the brain and understand how the therapy is impacting the body and then turn around and and adjust that therapy to optimize it and like I said personalize it. So this is something this is one of the many products were were launching today also. Recently got an expanded education in the cardiac rhythm area, which is really where the company was founded on a pacemaker for. A pacemaker which I. Haven't four on your show the Micra this thing is growing in forty percent plots in the middle of the pandemic, and so it's products like these that we have today it's really powerless four but then there's you know in the future, the next eighteen to twenty four months or some very large exciting markets. That were either disrupting like in robotics, searchable robotics, or creating like renal diener Vatian, which I think you and I've talked about. This is for hypertension. This is resistant hypertension. And we expect that market to be with just one percent penetration that would be a three billion dollar market for US I love you. Years. procup when you talk about. Something involving. Say Back. Issues that are surgical robotic issues because they say hold it made me. You've got something for something that I do not have any hope for how about giving us a little bit of hope because you made a great acquisition. Right Missour- we made the Missouri acquisition a a couple of years ago in our spine business, and really we we medtronic twenty twenty years ago really revolutionized spine surgery with pedicle screw systems, and now we're re disrupting it again with robotics and what Jim. Way. I'd summarize it is robotics is GonNa take back surgery and today it's an art form and is. Really, dependent on the surgeon that you go to and we have a lot agreed surges in this country but you know around the world that's not always the case and we're going to take it from this art flung to science with robotics interoperative imaging surgical planning tools. We just did an acquisition for incorporating artificial intelligence into our robotic system to personalise. The implants, the personalize the size of the implant. So it's a broad strategy and spine. back surgery that I think we'll have. looked. Into my first reaction was I should be asking my doctor's going to hospitals that have this I want the patients to have more control over their own body rather than just being shuttled different people. Should we be asking for this product before we back surgery? Absolutely and I think this is an opportunity for metron too I think historically, we've been more of a a B. to B. Company and I really think this is time for us to start to drive awareness with consumers about some of these new exciting therapies like robotics respond like renal diener vacation for a resistant hypertension. Are. On all kinds of medications tough side effects of you can have an integral, a minimally invasive interventional procedure like a in and out day procedure to well in materially lowers your blood pressure. That's something you're going to want to know about. So I think we have to do a good job of getting this word you're talking. About brainstorm, which is remarkable. Nobody has it. You're talking about back surgery that nobody has anything like you're talking about things that are disrupting all mattis what you really talked about the brand new medtronic's for us on. It is I mean it is in several ways. One look the pipeline we talked about. That is the foundational element of it, and we've also made some changes over the last couple of months. To decentralize company to putting our decision writes down into our operating units. We've gone from effectively one thirty, billion dollar company to to twenty one and a half billion dollar operating units that that are very aligned close to the customers. So I think it's GonNa, make us a faster more nimble and decisive. That's a chip nuts and other change, and we're really trying to add in addition to this mission driven culture. We have made some cultural James, we have a great mission. We WanNA, keep that mission but add a bit of being bold with some of these opportunities like really make the bet on like Reno beaner Dacian or or or robot surgical robotics for spine were for general surgery make bigger bet there it's be bowl and and and go for it. I like this Jeff I I like med try before I.
"resistant hypertension" Discussed on Cardionerds
"Two eight and now she's zero point six, nine, a definite increase, an indefinite component here of pre ECLAMPSIA contributing to her development of her failure we know that women with creek clamps yet have adverse left trickier remodeling around the time of delivery in even after delivery on Echocardiogram studies that we have done in the pair of in. So I'm so you need to have a really low threshold to Echo patients with pre ECLAMPSIA. Or symptoms of heart failure that is essentially a practice pattern at the University of Pittsburgh. It's partially to identify any structural cardiac. Changes. By dysfunction but also because pre clancy a runs along with Kirk pardom cardiomyopathy in this part of the pathophysiology pathway for some type of pardon cardiomyopathy with ECLAMPSIA, we see abnormalities in measures of diastolic function. So decrease in tissue doppler e prime an increase in the prime suggests increase in left atrial pressure. We see an increase in tricuspid record velocity. Suggesting increases in pulmonary artery pressures. We also see changes the left ventricle higher proportion of left hypertrophy increase in left ventricular wall thickness, and remodeling. We also see that the left ventricle diastolic diameters increase. So these women have increases in chamber size that go above and beyond what is expected for a normal pregnancy, and this is not actually unlike an athletic. Heart in terms of the regular changes we see in pregnancy, but with the pre-clampsia changes are more pronounced this segues nicely into the question of pulmonary hypertension. In this patient presumably, she has sort of a combination of group to in group three pulmonary hypertension were primarily we would suspect to her elevations NPA pressures are driven by her elevations in left sided. Billing pressures but there may be a component also of untreated sleep apnea contributing this patient is morbidly obese and so she may have obesity hyperventilation. So it really is multifamily theriault. There are some studies that have looked at pulmonary hypertension in pregnancy, but not many that have differentiated the different groups of ponant hypertension and how that influences outcome. So on the extreme. Side we know that congenital heart disease and especially in patients who have is in members associated with high morbidity and mortality pregnancy. Any type of pulmonary hypertension is not benign, but there are some features in our patient that suggests that this might be a more mild for her. So mouth pulmonary hypertension and all group to group three pulmonary hypertension doesn't have. That same increased risk of mortality that we see with group one, but it does carry a significant increase in morbidity when compared to patients than outward hypertension. So it carries an increased risk of preterm birth heart failure have Arrhythmia, and so this isn't up a nine condition for this patient it deserves a sub specialty involvement and careful consideration of pregnancy management for. Her so what is the optimal management of course diuretics and that's really per symptom benefit to decrease your blood pressure to decrease your likelihood of worsening respiratory failure. But the obstetricians want us to be careful with diarrhea necks in patients who are still pregnant, and that is because we want to be careful not to decrease perfusion to the fetus. So you. Know generally, we watch very carefully support perfusion parameters. We just don't want to Overdo with diuretics aspirin effective for clip prevention, and we actually have more therapies coming along the pipeline. So there's a randomized clinical trial that is ongoing to assess private staten in its role in pre clancy of prevention, and these there is really suggests that brick Lancia phenomenon that goes. Above and beyond kind of dynamic changes associated with hypertension, there are abnormalities occurring at the vascular level data really important to recognize. So there's endothelial dysfunction, but there are also changes that we've identified in Santa called deciduous vascular apathy that are more sort of atherosclerotic type of picture and these all contribute to proclaim clamps yet, and also I suspect are related. To the cardiovascular changes museum later, life in terms of hypertension management knife etta peanut is the agent of choice for me there on a couple of studies that have shown that it is the most effective at blood pressure control. It's also easier for compliance for women because it's a once a day medication my next go to battle and oftentimes cardiologists were involved. With these patients care if there's resistant hypertension so we may be turning to third and fourth line agents and I was suggest diuretics and also hydrology, which we can use either in Ivy your oral form. Now, this patient presented at twenty nine weeks and was expectantly managed and I think that's appropriate but there's not a straightforward right answer here it really. Warrants discussion from the obstetricians and also with guidance from the cardiologists among women with pre ECLAMPSIA. Those who expectantly manage longer than seven days are at increased risk for adverse cardiovascular outcomes around the time of delivery, and also in the one year postpartum this is increased risk for heart failure for 'em I for cardiomyopathy cardiac arrest in even cardiovascular related death. So. Although it may make sense from the fetal perspective to prolong pregnancy. We also really need to balance the fact that it may not be the best for mothers and so at twenty nine weeks that's something we really want to try to push to expectantly manage because delivery for the fetus at that time carries high morbidity, but we didn't I don't think. At the end of the case where actually this patient represents at thirty four weeks acquiring induction of labor and for severe pre. ECLAMPSIA, if they've achieved thirty four weeks of just station, then we really want to try to deliver them at that time. So that's in line with the guidelines for management from the Ob side of things and this kind of segues. Nicely, into highlighting how important it is to have multidisciplinary management of these patients we are so very lucky at the University of Pittsburgh to have a very collaborative relationship with our obstetricians where we need monthly to talk about our high risk cardiac patients, we have a very robust partnership and ongoing communication about the patients that we see together for pre climactic patients. Almost equally as important to pay part of management management in the postpartum period, and that was really pushed us to start a postpartum hypertension clinic for patients with pre clancy and other hypertensive disorders of pregnancy the risks for these patients, Harry's beyond delivery and for women with severe clamps. Yeah. About forty to fifty percent of them have hypertension at one year after. and that hypertension risk as walls cardiovascular risk forward into even just the ten years postpartum. We've actually shown that on Echo cardiograms at eight to ten years postpartum. These women are increased risk, for LV remodeling even when they're further out from pregnancy. So this management post-partum is extremely important and really vital for helping to get these women on the right path for prevention in later life in our clinic, it is run by both cardiology as laws maternal fetal medicine, and allows us to address all of the issues that women can face when they're in the postpartum time period. So we do blood pressure management we also. Talk about cardiovascular risk factors in management of those, we also service liaison to other sub specialists to sleep physicians to nutritionist to.
"resistant hypertension" Discussed on Cardionerds
"Outcomes were changes the course in pregnancy, and in fact, we worry if we make patients to hypertensive that we're going to reduce things like. It'll perfusion, and so that's why our treatment rumors are. So conservative and pregnancy, and obviously very different than patients that are pregnant. So for this reason, he actually doesn't have a clear indication to start her on anti hypertensive at this moment beyond her pulmonary Dima, which of course, is a superhero feature and an end organ dysfunction but I'd actually aim to just treat her with diarrhea and then just what happens what pressure is at this point he's I. Bet they'll get below this one forty range that we to find her pre ECLAMPSIA at so agnes what I'm hearing is you wouldn't put it on Capitol Hill six point two, five, milligrams Ti d and update. Got It. Right I would absolutely not put. On the days. That would be out some last stroke I would put on but cracks. Yeah. Yeah. I. Think we're much more conservative about blood pressure. Right and it's. A little bit tongue in cheek but. One of the things that makes me nervous when I encountered a pregnant patient on the console service is just being mindful of all of the things that we don't want to expose our patient or are baby who's also our patient too. So obviously, Noah's arbs no sprint electron obviously the debt remind formation there is limited and so. All of us to really look it up every time. Well, that's an hour talking about some of the resources that we use because it's not something you're going to be using unless you do this as your primary career it's not something you're using frequently. So some of the resources that we like to cross check in terms of what safe in pregnancy as. Well as with saving breastfeeding because they're not one in the same is lacked med agnes you said you like infant risk if risk is a really nice I, think it costs a nominal amount, but it's really nice because you can basically very easily check any medication and it breaks down actually by trimester and then in the postpartum setting, it'll tell you it's For breastfeeding or not, and it's really nice to use crosscheck Almighty. Is also really nice up at a lot of our residents residue used walls are cardiology fellows that's specific for lactation breastfeeding. But I agree with you I think medications are when the that makes us nervous about the pregnancy population but I think there's so many apps and resources out there now that it shouldn't be a barrier really for us t care patients grew thanks. Thanks for remember offhand is ace inhibitors during pregnancy are contra indicated, and then if you need to go to try like either Lieberthal if severely hypertensive, we can do hydro they do use night fettuccine. Then ob uses a Lotta method OBA, which really has modest effects but used frequently as well. Super Helpful guys. Thank you so much. All right. So now that we've talked about. What we're going to do with her pressure. I, guess the real money question is when does cardiology typically get involved in the care of patients like this Yeah Greg crushing Kelly is it sounds like barry mentioned of UK's but it's actually not. So the mcgeough begun department and the Heart Vascular Institute has this really great collaboration given deliver a lot of high-risk patients you're at. And as a result, we have a lot of interdisciplinary meetings to talk about the energy needs patients, and then of course, as we alluded to throughout this presentation, there's increasing evidence that a lot of the of pregnancy or cardiomyopathy as parents. Are linked with later life cardiovascular complications. So there's been such a big push to streamline follow up in assists in transitioning care to our patients in the post art upsetting if you look at the incidents curves in patients from diagnosis of their hypertensive disorders of pregnancy to when they established coronary disease as compared to age and sex matched controls the curves actually started diverge some around fourteen years from their hypertensive disarmed of pregnancy diagnosis. So that would place this patient at forty years of age, which is extremely important for. No right consists would police are at risk for early? So collaborating again with our McGee associates are obgyn is extremely important. So getting back to watching Qe, we actually put forth guidelines at our institution head that went to console cardiology targeting serve high risk groups, and they're essentially any patient that comes in with severe resistant hypertension in the postpartum setting requiring two or more medications for blood pressure control. Anybody that's readmitted for retention anybody that's coming in for Frank Carts failure anybody with. Dima in the postpartum setting, anybody would severe cardiopulmonary symptoms, severe pre eclampsia requiring returns delivery, and then anybody with the significant history of early hypertension, cardiac disease, prompt PRONTO, cardiology consults, and now that cardiology consultant will feel very comfortable in the management of this patient. Definitely. So we talked with some of our initial imaging. So her chest, right, you know we also talked about the concern about any structural abnormalities. We don't have a history of that in it's patient but do you think that she needs any additional imaging Monaco a cat scan anything like that? Yeah. So I think she is enough abnormalities including a pulmonary Dima. She has signs of Frank Rate Hartsdale your that I would pursue an echo winner keys. A lot of the cardiologists say the rule of thumb is essentially if you're giving lasix to appreciate, you should be getting an echo and to put a plug in for Cardio obstetrics team affected interdisciplinary care is super report your I think our NFL colleagues or pre ECLAMPSIA? lasix essential common drug in our real house and so is cardiologists were actually very helpful in giving guidance just not least extorting integration and again I think it's going to be helpful in managing this patient from a pulmonary musty in a blood pressure standpoint so I'd recommend. That just diary recess at this point regarding additional imaging like Natalie pointed out pregnancy is hyper arguable state. It's always reasonable to entertain in the differential given we have a chest X ray with pulmonary. She's not high pock static and we're always balancing the risk of radiation have pregnancy I. think it's safe at this point to go any kind of C. T. A. Work up for pe E. WE have higher things on our differential. Did they.
"resistant hypertension" Discussed on MedTech Talk Podcast
"For being pocket of. If I go too five. So our approach with the reflective ation is designed also to work for the treatment of high blood pressure or assistant time protection in its Egypt explain this real estate example with hypertension. So think about your office Rijeka that set most on the ball. Sensing the temperature. And if the temperature is too high. It says wall I did to inform in my instant computer that I need to get cooler air in here right now. So the federal stats sense order to Hvac, actually information the HVAC computerized system starts the compressive cool down the air stop sending more air opened up the the vans, an Anon- anonymous gasket of events all starting from that set stats. Now. If we cannot modify the stats and it's Set at seventy six degrees sweating. Could put a chair and tried to open up the vents. It is not going to help because as soon as we hit seventy six degrees, the feminist that will stop the flow of air. How do we change this? While one trek would be to change the Diet of the staff. But what if the died is broken when another trick is to take a match and lights and heat the surrounding right at that time was stat. So the local heat from the match that your all your fingers. With trick. That into believing the temperature is eighty degrees. So the federal starts to down to seventy six in fact, it was seventy six we got seventy two so you see that I'm hitting the sun was that to cool down. That's exactly what we're doing with the better sceptres we activate them electrically we took the brain into believing that is so much pressure. So much pulse ations there that we need to slow things down even further and then the. Brain yachts to that source of information that we're sending and slows down the Hart Dynasty Oddity Alexa Kidney and all of this happened through two sets of nervous systems It's called actually the autonomic nervous system. It has two sets of flies think think about them like the gas pedal, the brake pedal, the gas battle is the sympathetic tone. When we send signals from the brain to the organ through the sympathetic dome. It is meant to the system. This is the fight or flight mechanism. On the other hand. The Patterson pathetic tone is the break when the brain sends signal over the past pathetic toe or the Vega tone. It's meant to slow things down. That's the rest and Digest. Just. An anecdote in hidden text books they talk about the four basic limited instincts of mammals, animals like the human. They, call them the four. So fleeing fighting on sympathetic one. And then feeding and the productive system that society the fourth odd about Patterson. And those to are balance usually in our body for normal, you're beings when they're saying when did know everything's going well in their system, they have a good balance between the sympathetic Patterson public system. Would going up a flight of stairs. Sympathetic system kicks in we're sitting down after. Feeling, sleepy in a we need some rest. The Patterson pathetic system is up and we keep balancing those up and down. Now unfortunately those patients suffering from heart failure. or those suffering from resistant hypertension they have an imbalance that sympathetic tone is too high that better sympathetic is STU low. Buddy is grabbed all of the time. It's like you're standing up sitting in your car, your foot on the gas pedal all of the time. Even. Wind. Likes. Right, you're standing guard at your revving the engine, you'll kill the android. You can't do this twenty, four hours a day seven days a week have to have some times of. Fast That's disabled hot over years and years of being over at beating very fast, very vigorously all the time. Hearts are becoming larger in the loss thinner in its was its ability to pump properly. That's how failure it's complicated the at node. So interesting in data. Yeah, and the you know now the proof is kind of in the pudding last summer crx achieved a major milestone in its history with FDA approval. For symptomatic improvement of heart failure and could you describe some of the results from that study in and maybe also put those results into context we think about other therapies in heart failure. So. When we started the venture in heart failure, we decided to three sequence of thron phase one first in man study. Trod called feasibility study that was meant to collect the evidence and to size fact, and then the third pivotal tried to seek get FDA approved. So the Serbs Franck called beat the Jeff. Is the one that was recently published in the Journal of the American College of Cadillac Jack beat that chef as demise control, thron Ed we in, distraught? Out To demonstrate what we always said. It would happen which is when you put this device in patients suffering from heart. Fadia. That would feed better their functional status will improve. So then go from maybe a class, three Hartford of the last to less severe form of the disease. That can exercise more that can walk longer. It can live a fuller life. So those are the symptoms. That we believe before starting tried that our device will impact. By the end of this. Trial we publish the results and you can read them in Jock. We've demonstrated that our device improves. The exercise capacity of patients by improving their six minutes walk by sixty meters. And let's put those results in perspective and give you some numbers. Usually the heart failure in the medical community at large believes that an improvement in twenty five meter in the six minutes hall Walk Desk. In Heart, failure is clinically meaningful. Our device improved sixty meters. So that's two and a half times. In that is a measure called the quality of life using the Minnesota living with heart failure question at it's hysterical dice desk. It's one of the two deaths that FDA recommends demonstrate whether the patients are living a better life. It covers a lot of information about.
"resistant hypertension" Discussed on iForumRx.org
"Which is about twenty nine percent of the population studied method. Daytime MEANS TO STOLAC bloodpressure goal of less than one thirty five millimeters of mercury and fourteen out of forty six patients. That's thirty percent met. The daytime means Hispanic blood pressure. Go at one month so Megan. Obviously the study doesn't have the same rigor as a randomized control blinded study but given the nature of this problem in the intervention mainly directly observed. Treatment I'm not sure it'd be possible to blind such as study in your opinion. What are the key strengths and limitations of this study? I Agree Stewart. That would be very difficult. Some strengths of this study design. That selection bias is eliminated as participants are not generally selected by who might be more or less likely to have the outcome of interest in so prospective cohort such as this one also set up an easy to follow sequence of events between the exposure and the outcome so in regards to strengths of the study as a whole I would say that it overall scenes easily implementable. I would state. That elimination might be that. The fact that the nurse questionnaire was not clearly defined. So we're not really sure the questions that were asked or how they were asks in. A non judgmental manner to ensure that the patient could answer truthfully about their perceived adherents and the other things that we could think about as relates to strengths and limitations of this particular study. Is that races not actually mentioned. When they talk about the demographics and I think that would be important. Certainly In our country as we do see that minorities tend to have a higher risk of resistant. Hypertension also. In this study it was done in Canada so they have a national healthcare system and so a lot of the patients had insurance there. Were I believe maybe four? That did not have insurance so That's something to consider as we often encounter in certainly working at a federally Qualified Health Center. That's something that I encounter on. A daily basis is dealing with the socio economic issues. That play into why are patients cannot be adherent or don't have the means to purchase their medications or the treatment that we would like for them and then in general representation of men and clinical studies. We know Tends to be higher With our most of our patients in this study being men. So that's just something to consider as well great so let's return to the case of RL. What should we do? Do feel directly? Observed Treatment is worthy of trying in a case. Like this. And if so how would you go about implementing it? What are some of the logistical issues? That you need to consider and how would you respond to the results? Thanks stewardess really good. Question ideally the patients should be goal with being on four blood pressure medications and with that we want to definitely now consider it hearings as being a major problem that we should. I address and that can be addressed in many different ways either via discussing pillbox or synchronized fills a reminder APP. Some type of technology to assist the patient with her medication adherence directly observed. Therapy may be an effective tool for this patient as it could be a helpful way to rule out if it is truly treatment resistant hypertension. Some logistical issues. That we considered would be how it would be implemented because directly observed therapy can be implemented in many different ways. Some issues that we might come across as we are potentially thinking about. Dot is accessibility. We also want to make sure that if I'm able to set a prearranged time they're fit both pharmacist schedule and the patient schedule in order facilitate that directly observed therapy thinking more long term. We want to also consider reimbursement for pharmacy services. Being at this is outside of what the normal role of the pharmacist might be and ways that we can make this happen in generally in a clinic setting as it would expandable the pharmacist. In addition if the patient's blood pressure responded well to directly observe therapy this could indicate an issue with adherents and we could potentially get the patient to go without changing the therapy but emphasizing adherence and ways to ensure that the patient has the ability to adhere to the regiment's if the patient's blood pressure does not respond well to the directly observed therapy. We would need to think back on the medications that the patient is on to decide if we need to make changes to the regimen or even looking at the timing in which the patient is taking the therapy so Meghan Raven. I WanNa thank you both for joining me today to discuss the treatment of hypertension treatment resistant hypertension and the potential role of directly observed treatment. I think it's clear from your comments that you believe there. Israel for Directly Observed Treatment and it can help us sort out between apparent treatment resistant hypertension and those who truly have treatment resistant hypertension. Well tell us what you think. Only I former ex members can leave comments. News use the interactive features on the site. You can become a member of by former ex. It's free so sign up today and good news..
"resistant hypertension" Discussed on iForumRx.org
"So Megan Raven welcome to the IPHONE X. Podcast thank you for having US Stewart. I'm excited glance will be here so before we get started. I want you to imagine you're seeing our L. A. Sixty four year old African American female in the Primary Care Clinic today or a routine blood pressure follow up visit and the patient has a longstanding history of high blood pressure while rl is also overweight. She's otherwise healthy reports no personal history of cardiovascular disease but states that are older brother has some kidney problems and our father died at age. Sixty six from a stroke. The patient currently takes my center Pearl. Twenty milligrams twice daily Ida Flora size. I twenty five milligrams. Daily am low paying ten milligrams daily and last week. She was started on parental acton. Twelve five milligrams once-daily. She currently weighs two hundred pounds. That are being is thirty. Six point two her blood pressure. Today's when fifty two over eighty four and a chem seven was drawn this morning. Her electrolytes were all within normal limits including her serum potassium which was or point one a serum glucose of ninety six of serum creatine of one point four per estimated. Gfr's forty six miles per minute and as you through her chart you note. That are alien. C. was six point two percent and her. Ldl Cholesterol was ninety six. Hdl cholesterol sixty four and triglycerides. Were one eighty eight a few months ago so before we talk about the study that you reviewed in your commentary. Can you tell me a little bit about the things that are going to your mind in a case like this? What additional information might you want to collect and assess during this encounter certainly Stewart? Rl sounds very similar to the patients. That I see every day when I'm in the city. We are certainly concerned about her blood pressure. Her family history has some information that we may need to ask a few more questions about and of course she's overweight which is what we typically see also here in Mississippi some things that we would want to consider is just looking at of course her adherents and since the patients already on for blood pressure medications. We WanNA take a deep dive into that and make sure that we understand any barriers that exist to ensuring that our L. is able to get the medication she needs and in addition some of the things that we consider would be her health literacy level Her current job or hobby as well as her diet and lifestyle as some of these things are mentioned here. Some Diet and lifestyle points. We certainly want to emphasize with this. Patient would be salt restriction losing weight so approximately ten percent of her body weight would be helpful and then of course avoiding over the counter insides stored in regards to some of the additional information. We might want to collect or assess during this encounter. We also want to collect her social history specifically regarding the smoking total cholesterol in order to properly assess ASCAP DE risk As those are information points a missing it may also be helpful to know if the patient is using any over the counter medications as none of those are also mentioned medication. List in regards to labs it might be relevant to collect coronary calcium as well as hse or a P as these markets that we know can affect Ascap de risk according to calcium is being used more often as a marker for disease arteries and moderate elevation than ASCAP generally between one and ten is likely indicative of chronic vascular inflammation and usually an hse are greater than two is commonly seen as the threshold for ASC D. ADJUSTMENT. So we would like both those avenue area as well as sodium levels might also be helpful in regards such better assessing the patients kidney function as her. Gfr Is a little on the low side. Some additional treatment options that we might consider The patient does have a couple. Afcd major risk factors including age and high blood pressure the tenure AFC VDI race was a little hard to calculate being that some elements were missing. But it is likely to be greater than seven point. Five based on the patient's risk factors moderator high intensity. Staten might be appropriate based on his patients. Afc DVD As well as the fact that they ldl is between seventy and one eighty nine for example a tortuous than twenty milligrams. Daily might be a good option. Also may bigger option for this patient because it there's no adjustment for moderate renal dysfunction. Wish the patient does pass and looking at her medication lists so being on what's recommended per the guidelines Lucinda Pearl. She's on H. E. T. Z. Twenty five and a calcium channel blocker and loping. She is maxed at all three of those and additionally has been given spiritual tone at twelve point five milligrams which is a decent starting dose so the addition of the fourth line agent again is is something that we would typically do and is an appropriate next step in the management of apparent treatment resistant hypertension with the twenty milligram. Listen approval being dose twice-daily though is generally dosed once daily. We are aware that the elimination half life of listen apparels only twelve hours which might explain why the provider decided to go with twice a day. Dosing some literature does suggest improve blood pressure control with this frequency and so we would consider leaving that as a twice daily medication additionally. I have read studies and we know that taking a blood pressure. Medication at night is helpful in managing hypertension Just having the ability to lower the blood pressure I would just WANNA speak in. Regards to the sparrow intellect. Home twelve point five once daily dosing as Megan mentioned that is an effective for agents to add on. We do have some room to increase this agent to maybe twenty five milligrams daily or we can do that as twelve point. Five milligrams twice daily specifically about two weeks. After the initial treatment has started we may be able to titrate up to one hundred milligrams but we would want to be cautious of increasing their dose and a patient who does have some level of C K. D Wilson of the higher dose of elect. Home could also improved the patient's potasium level which is at a four point one still within the normal range but on the lower end of normal. Who Want to be mindful of pass him levels so we want to make sure that that is addressed. And then lastly we wanted to assess the patients prediabetes whereas given the eight one. Six point two we. We think that a confirmatory test should be conducted via another a one C or another method of diagnosis to determine if the patient does indeed have prediabetes. Considering a patient's weight in additional risk factors it is likely and the addition of Metformin five hundred. Maybe as a once daily dose might be an appropriate star for this patient again in combination with some diet and lifestyle modification specifically around carbohydrates and mill portions so raven. Let's talk about the results of the study reviewed for former Ex. The paper was published online in June. Two Thousand Nineteen in Jama internal medicine and is entitled use of Directly Observed Therapy to assess treatment adherence in patients with a parent treatment resistant hypertension now for those in our audience. Who haven't read that paper and it's a research letter actually. Can you give us a brief summary of the analysis and its major findings sure? This article looked at non adherence again as it pertains to apparent treatment resistant. Hypertension. The study. Were enrolled several patients. Who had parents remember? Hypertension undergo was known as directly observed. Therapy abbreviated as dot with blood pressure. Monitoring in clinic Until the medication reaches peak response there were questions that were given to the patients to assess adherence from a nurse. The primary outcome was to see what proportion of patients with meet the daytime systolic? Blood pressure go after. Dot and the secondary outcome looked at if that goal was met one month post about sixty minutes enrolled in the study and forty eight actually went through and we were able to gather results from..
"resistant hypertension" Discussed on News Radio 810 WGY
"Joining me in the WTY studios this week, the one and only Dr Robert Benton. Welcome back. Dr benson. Thank you. Mike. Glad to be here. I was trying to keep track. And I think we should just start it for the new year. How many times you make an appearance here? One of our most favorite guests to have on the program so much else. Do a Sunday afternoon. I don't find that to be true, Dr Benton's board certified in cardiovascular disease, and we're gonna be talking about a subject that we've not yet. Really dove into too much this week, which is congenital heart defects and congenital heart defect awareness week. I though in our heart news and trends, you know, this is something that you've been kind of banging on a lot lately as women just don't seem to recognize the symptoms of heart attacks, the classic symptoms that you know, we tend to think so and they are now waiting longer to get help. We find that women wait thirty seven minutes longer to get treatment for heart attacks as opposed to end. This is new sweetest Swiss study that happened and they find that this delay that women don't recognize or experience the same symptoms that often have back and shoulder or stomach pain. So if you're living with a woman, and she's been complaining about having a stomach ache for how long would you say an hour a day like when should you start to be concerned about this? Dr Ben I think I'd certainly look at the the person, I certainly if a person has a smoking history, diabetes, hypertension, a family history. Then we sorta say anything from kind of the pelvis to the the neck, those are things that you need to worry about for potential signs of a my kernel function a woman can never be too sensitive, and what's the loss you call nine one one you go to emergency room, you get checked out so better safe than sorry. And that's it situation. The author had said that any moderate to severe discomfort from the chest as you said warrants a call to nine one one the Jackson heart sleep study found that sleep apnea can make it harder for African Americans to get their blood pressure under control among participants with high blood pressure. Those with moderate or severe sleep apnea were twice as likely to have resistant hypertension than those with those sleep issues at all now what the study confirms. According to authors is that there is a link between sleep apnea and heart to treat hypertension, can you break that.
"resistant hypertension" Discussed on The Bio Report
"Levels. Most of the time had an elevated level and thanks to our new approach to treat hypertension, and as a city cardiovascular disease. I mean, that's type attention hurts fater, but there is also potential for although indication we seamlessly decrees the person released we decrease the sympathy sympathetic nerve activity and wing pries, the Bowery flex. So at the end of the day, we have three actions if I miss it that wing priest diaries, which is unitary enemy nation. We lower vascular Ariston's, and we control it hurts. Right. So that's why this innovative drying target new Suntron from a digital pathway. Leading to both, hyper anti-impotency, fakes and call you protection. And is there a way you can actually test a patient to determine whether this would be the best approach for them. Can you tell if they have an elevated level of this enzyme to to begin with? There is not the compensatory misty for that. But we don't need that. Because you know, the resistant hypertension patient is a patient treated by sweet products as I mentioned before one of them being Darah, dick. And then this is very simply in a way that if the patient is not a target and the target is hundred forty for the study blood pressure, and and many megrim. Macrey? I'm sorry ninety. I read it year, and I'm forty and ninety then if the patient is not the tar head then absolutely mandatory to initiate treatment, you know, to treat the patient. I think of most treatments having a systemic of vent are rather systemic affect your training, the an enzyme in the brain here does this have to cross the blood brain barrier to to work. You are absolutely right. And this is what's Siri bus that that they have to work a lot or on three because when we defined let's say the palm and it started with a neuro biology person at Sunday insurrection, which is researching student France. And then we had a lot of chemistry development in order. To make sure that our product here that was patriot in the brain. I how exactly does the product work. Simply maybe shown of the fifty a in the brand, which will let's say blocks the conversion offense in to enjoy having two hundred three. So that's very eighteen. Even they will blocking in the cascade. Also, one of the enzyme what's different with our product is that we act in the brain. And this is the first unique product controlling hypertension, and many resistant, hypertension, right anyting design at the Brian Little you actually got multiple products in your pipeline. What's the pipeline? Look like an and where's your lead therapeutic product in development? So the league countdown is furious tax. I spent thirty years in the in different the pharma company, and it's you know, it's very common to Evelyn count on and backup program. So we also working on different backup products being more protests or cheaper to prove that sorta ten me we in hypertension difficult to treat patients and hurt tater while lead compound, which is very best that so we just finished, by the way, the new hope study. The study was run only in the US in soda yet centers. And I were PI was to kiss Fairview. No way the purpose of medicine at the University School of medicine in New Orleans, and and not to be consistent with what I told you before they say to be clinical try on unroll, overweight or obese patient with prime very happen. Tensions station known to have increased incidence of treatment resistant, hypertension, such as black Hispanic has and senior population. And we got extremely good reasons. And then have two common those results if you one, and that's the reason why now we will initiate the people face retrial in registering, hypertension, which will lead to restrain him. What about the? Protest from a clinical point of view in terms of safety or efficacy. When we got. Extremely good. If he gets that. And we had a very good safety profile interface in the in the new study again and this product is. Product. We were we had OB station we tension and to station. I mean, we know that obesity increased by five phone the risk to be resistant to the treatment. And in those patients, we had the six month. Let's say we were six months and schedule, and we were able to use the offices to blood pressure from baseline Vina's, racial nine point six meter of macrey, which was highly significant because the target was defined by the and I were steering committee or target was to decrease the office pressure by sentiment of. So we've nine point six we were we happy with the results, and what will actually mentioned. So here is that we that. She could see was also senior in the black and then black populations the contrary to of on T, hypertensive classes, and this is what you'll be the the the arts. They don't work in such relation. And we were also weta righted and we were able to demonstrate an accent on metabolic, and and the safety profile. So that's why they on the results we will initiate face repeal. Don't try in eastern, hypertension, and we very you're also developing a treatment for heart failure, this is using the same platform of the same drug. Yes. This is this is a sensory we based on the exit. If she gets that in animals and good fifty profane pilots today. We will initiate this is working progress face to betrayal, and that would be without if he can see and sixteen patients with reduced ejection fraction after acute myocardial infarction and head to head the versus the reference therapy and the restaurants there is and as a hummy premium what happens in heart failure. And why does this mechanism mechanism of action seemed to if at these patients? Where you know in her chair? It's it's difficult is many many products of try and the simply not succeed because the nicotine is my action. I would say is not as simple as it is in hypertension. Most of the time the patients are suffering from different disease, which was switch more competed to treat the patient. What we have demonstrated is our TV on the Reynolds synthetic nerve activity and also our TV on the exemption fraction wearing that's different TV. What we want to to months writing in heart failure. And how's the the company finance to date and how far will confronting take? You. Well. We have I would say enough money in the Bank to finance all our project this year in twenty nineteen. So the project is to finance the face to be proof consensus in heart failure, the people try to face three in resistant. Hypertension will also working on the ones that they formulation today. We have the ID twice a day, and for resistant, hypertension, it's very important to have once formulation. So we're also working on that. And and we have enough money in the dank to silence all those projects at the same. Time Wong, Chris contact with a lot of pharma companies who have demonstrated an interest in our product because I want tension is to to sign the punisher. And if all goes, well, what's the? The path to market has soon might you be able to file. And by the end of twenty twenty two JP moth CEO of quantum genomics, J P. Thanks so much for your time today. Thank. Any? Thanks
"resistant hypertension" Discussed on 860AM The Answer
"He's all compounds that help your body first of all fight a bug off. If you get one, but more importantly get on it before the season started taking it now. So that you can really get your body ready when it gets challenged, and that's what. I really like about the Formula one of those three something that people can take every day. And and you know, there's not a lot of products out there that they've done human. Studies have shown. Oh, yeah. Big big drop in severity duration. And intensity. Right. Right. So so it's really important to understand. I mean one of the threes. Great compound, and no people don't understand all just eat garlic eating garlic, not the same thing. While it's good garbage. Great. And it does have some benefits medicinally. It's Nate state. Once you aged it changes, the physical properties of it. Just like when you'd make cabbage in the sauerkraut. It changes the properties of that. Right. Right. Yeah. With aging the garlic changes the properties. That's a good question is a good segue into leading me to my next question. And that is last night as one of my dishes. I I didn't make it to you. But I I I was at a deli. And and it was one of the items on there. It was roasted garlic broccoli. And so I I purposely got several close the garlic more garlic than I got broccoli. Now. How many let me ask you this? How many cloves of garlic, maybe the cook? Garlic. I like what it takes to be equivalent to say one dose of the kayak aged garlic extract the owner, excuse me, odorless, garlic. Yeah. You couldn't do that. Because roasting it is different than aging it, okay? It. It's literally aged it so chemicals over twenty months almost two years of aging and new chemicals form from the garlic natural compounds. That are water soluble you get you get a compound called s Allio Sistine, great sulfur, donating compound. There's probably Saka rides. There's all kinds of interesting compounds that grow out of the aging process. So if you roast garlic, it tastes great. If you crushed garlic, a taste great. I love garlic. I'm telling you, I love garlic. Anyway, you give it to me. But if you're looking for the clinical benefits that have been studied on garlic the over eight hundred publications now have pointed to the value of age garlic extract in comparison to just regular garlic. Okay. Realize that that that aging process is Mexican different? Now, the other benefit is you don't get the stinking rose affect you eight seven closer roasted garlic, and I have to tell you about on the mainland today. And not in the studio just saying. Hey can cut you off at any time. You know, probably I'm you right now. So so the point is when you age you lose the volatile compounds that make up that they've that kind of sent a lot of people get garlic, and you also don't have to worry about blood thinning properties. Oh. That's a big one. And the other thing is you get in addition to the immune benefits. Now interesting. They did a study where they gave h garlic that people in that in that that students study here, it changes, the what's called the gamma delta cells when you take it increases, the immune cells responsible for helping you respond to colds and flus. Oh, your your gut is where your immune system's at. So in the intestine it up regulates what's called gamma, delta t cells. And so basically, you're immune cells start to grow that they start to get more active than the ones that are responsible for cold and flu. So it's really pretty interesting, and there's some other interesting effects. I think that are going to become more known or some preliminary evidence that it changes the microbiome it makes it more diverse. Probiotics. Help your belly. And help you fight the flu. Making sure that you're doing that as well. I mean Formula one or three the one that's specific for cold and flu from the from Kyle liquor, the H garlic guy, obviously, garlic company, great product. I mean because it has other things. Vitamin C, mushrooms. Reagan. Right. Exactly. Okay. And then since you mentioned the odor of garlic. Here's something that says, as you know, an apple a day keeps the doctor away an onion or a clove of garlic a day should take care of everyone else. Exception to that is because although he said, it has all the healing power of garlic. And then some it does not have the odor of garlic. So people don't have to worry because a lot of people have taken garlic supplements before even garlic and parsley, which is a joke because the parsley doesn't really neutralize the odor of the garlic at all. I used to take that myself, and I've taken taken Kyle. For ever since the seventies. And it definitely does. I mean, I've had girlfriends no comments are it. Oh and problems in that arena. As far as the the body odor. Coming out, your sweater, pores or anything. And so it really is. And here's let me the before the next breaker, the last break of our Jim I want to share with you and the listeners you may have seen this. This was in the recent life extension magazine, and it says how h garlic extract can or how aged garlic extract Ken slash heart disease risk and they say since the nineteen fifties. Scientists have been researching garlic with particular focus on heart health. And I mean, this this article the summation of the studies, I mean, anti inflammatory effects broad cardio protective effects, reduce cholesterol levels, lower blood pressure. And I know that you can speak to this and more detail and the endothelial function in vascular elasticity. All important factors for cardiovascular health, which is the biggest killer in America. So. Yeah. No. I mean, what's nice about it as you get the immune benefits? So you know, cold and flu season the protected, but it reduces plaque and give your arteries. It was it literally reverses at so vulnerable plaque is reversed your arteries, get more, flexible and pliable. So it shows up to an eleven point in studies human studies mind, you wanna mice coming in with blood pressure problems. But it's the tiniest cough. I just can't get. Crazy. So so in humans, it will on average will drop systolic blood pressure eleven points. Diastolic blood pressure six points. That's huge. And that's even people that have what's called resistant, hypertension, people are already on medications. So you make the blood vessel healthier, you stop the plaque and you reduce something called oxidized LDL. So it's rusted LDL that's the stuff that blacks, your arteries. All right. This blot effect improving HDL's, reducing a really nasty chemical quality protein be that that really is a big contributor to heart disease. And then one of the big things is it reverses laying down of fat so visceral fat around the heart goes away fatty liver visceral fat for the liver goes away. Are you serious? That's going to be the biggest disease in the next in the coming decades because of well. Non non alcoholic Saudi liver disease because everybody has a fatty liver. These days, you know, with obesity. More more people will need a liver transplant do to non alcoholic fatty liver than due to hepatitis, correct. Spot on. No, no, that's the accurate statistics. Yeah. I mean, this is huge. And so this really should be one of the core supplements that people should take if they want. The most important. I really do. I think it's one of the most important in the last thing it does if blocks bone mineral density loss, so when you lose bone direct correlation of loss of bone to coronary calcification. So if you have an acidic ph I'm eating a diet. I got no vegetables eating lots of grains, and I'm eating, you know, lots of acidic foods can ground beating your meat greens. No vegetables. Well, guess what you're going to become acidic 'em. And when you become acidic your bone melts down to help you maintain the PH balance. Right. And when that happens the calcium gets released it goes to your arteries. Wow. Interesting. Vitamin k comes in right? It helps prevent that. From Dak occurred eight oh, okay. And then shifting gears to another product that walking Naga of America has the Cayo green blends the powder, you you were saying that if you don't eat enough greens, you should drink enough greens in the form of a supplement. And you know, I know. I know very few people that really eat enough greens. They might get enough protein, and vitamins and minerals and other things, but as you mentioned, the importance of greens and maintaining alkaline ph and detoxification processes, and so on tell us about the Cairo green products what I really like about Cayo greens. I would use the harvest blind that you're talking about cold.
"resistant hypertension" Discussed on AFP: American Family Physician Podcast
"Right so some clues that you might be dealing with secondary hypertension include onset before thirty years of age indefinitely before puberty and acute rise in previously stable blood pressure readings and lastly severe or resistant hypertension defined as a blood pressure of greater than one eighty over one twenty or hypertension that persists despite three adequate antihypertensive the first thing to do is to look at a patients medication last so many medications like oral contraceptives and chemotherapy to agents supplements like licorice and alcohol can all caused an elevated blood pressure then focus on the most common causes of secondary hypertension across all eight ranges riina vascular hypertension kinney disease hyper aldostur doctrine is on an obstructive sleep apnea started saaf evan first up is reno vascular hypertension this is common in with atherosclerosis and young adults especially women it can also be caused by fiber a muscular displeasure think about it when you start a patient on an ace inhibitor or an ngo tents receptor blocker and they're creatine increases by fifty percent or if you here arenal brewery although frankly i don't think anyone ever actually hear this i who laughing of faith push because athens middle name is frank about got our listeners needed to know so there's nothing an evan doesn't do that's nandan frankly a k back to a serious topic here so it's controversial which diagnostic modalities best but the gold standard is and geography however doppler ultrasound is less expensive and noninvasive you could also consider capped approval renal isotope nuclear scan which has a fancy name and also a good sensitivity and specificity.
"resistant hypertension" Discussed on AFP: American Family Physician Podcast
"Yeah there's actually a strength of recommendation a for attending the live podcast in kansascitynationalconferenceso sure you there hot off the press sohere's a special message higher ruin announcement fromkaiserpermanentefontana moslem residency and unless lizzymcintoshram city upstatemedicaluniversity we the student in resident chairs of the merit kaddoumi a familyphysiciansnationalconference for residents and students happening in kansascityjuly 27 th through 29 national conference brings together students and residents from across the country who are passionate about family medicine you can advocate for the future madison at the student resident congress's getting gulbuddin leadership lord about new clinical skills and hear the latest in practice changing since also you can discuss health policy in the primary care workforce connect with the diverse group of pierce received valuable career planning advice emmy over 400 residents he programs and residentsbill connections in skills to map out the next step in your career finally you won't want to miss the lie afp podcast recording you pause family madison be part of the nationalconference equation it's time for the annual top 20 research studies for primarycare physicians this is from doctors a bell and grad and these are the top poems of 2016 you guys remember poems are patient oriented evidence that matters good so poems are the most important research that are most likely to change your practice their relevant and valid that is they have low risk of bias and they report patient oriented outcome such as morbidity mortality or quality of life in 2016 there were more than 20000 research studies published but only 264 of them were selected for publication as poems palms are sent for free to the canadianmedicalassociation and they have a method of members rating the poems for what they think are most relevant to their practice so this article reviews the 20 most important poems of 2016 and we are going to tell you are few favorite from this article socleaneryou have the first one so there is a steady down on patients receiving maximal dosages of three medications for resistant hypertension and they found that sperone a lactone is the most effective at on medication for patients in this setting and his preferred over ducks as a sin or ba silver law for example.