0
selected
-
1.
Urolithiasis: evaluation, dietary factors, and medical management: an update of the 2014 SIU-ICUD international consultation on stone disease.
Jung, H, Andonian, S, Assimos, D, Averch, T, Geavlete, P, Kohjimoto, Y, Neisius, A, Philip, J, Saita, A, Shah, H, et al
World journal of urology. 2017;(9):1331-1340
Abstract
PURPOSE The aim of this review was to provide current best evidence for evaluation, dietary, and medical management of patients with urolithiasis. METHODS Literature addressing evaluation, dietary, and medical management of urolithiasis was searched. Papers were analyzed and rated according to level of evidence (LOE), whereupon a synthesis of the evidence was made. Grade of recommendation (GOR) was judged from individual clinical experience and knowledge of the evidence according to the Oxford Centre for Evidence-based Medicine. RESULTS It is obvious that different stone diseases influence the life of stone-forming individuals very differently, and that evaluation and medical management should be personalized according to risk of recurrence, severity of stone disease, presence of associated medical conditions, and patient's motivation. With regard to evaluation, dietary and medical management of patients with urolithiasis evidence from the literature suggest that selective metabolic evaluation may lead to rational dietary and medical management. Statements based on LOE and GOR are provided to guide clinical practice. CONCLUSION The provided evidence for evaluation of patients with urolithiasis aims at defining patients at high risk for recurrent/complicated stone disease. Based on this approach, evidence-based dietary and medical management regimes are suggested.
-
2.
A Review of Antihypertensive Medications, Part I.
Felicilda-Reynaldo, RF, Kenneally, M
Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses. 2015;(3):177-81, 188
Abstract
Hypertension requires careful management, including lifestyle modification and drug therapy. Use of thiazide diuretics and ACE inhibitors is discussed.
-
3.
Effects of thiazide-type and thiazide-like diuretics on cardiovascular events and mortality: systematic review and meta-analysis.
Olde Engberink, RH, Frenkel, WJ, van den Bogaard, B, Brewster, LM, Vogt, L, van den Born, BJ
Hypertension (Dallas, Tex. : 1979). 2015;(5):1033-40
Abstract
Thiazide diuretics are recommended as first-line therapy for hypertension and are among the most commonly prescribed drugs worldwide. According to their molecular structure, thiazide diuretics can be divided in thiazide-type (TT) and thiazide-like (TL) diuretics. TL diuretics have a longer elimination half-life compared with TT diuretics and have been shown to exert additional pharmacological effects, which may differently affect cardiovascular risk. In this meta-analysis, we compared the effects of TT and TL diuretics on cardiovascular events and mortality. Randomized, controlled studies in adult hypertensive patients that compared TT or TL diuretics with placebo or antihypertensive drugs and had ≥1 year follow-up were included. Primary outcome was cardiovascular events; secondary outcomes included coronary events, heart failure, cerebrovascular events, and all-cause mortality. Meta-regression analysis was used to identify confounders and correct for the achieved blood pressure reductions. Twenty-one studies with >480 000 patient-years were included. Outcomes were not affected by heterogeneity in age, sex, and ethnicity among included studies, whereas larger blood pressure reductions were significantly associated with increased risk reductions for all outcomes (P<0.001). Corrected for differences in office blood pressure reductions among trials, TL diuretics resulted in a 12% additional risk reduction for cardiovascular events (P=0.049) and a 21% additional risk reduction for heart failure (P=0.023) when compared with TT diuretics. The incidence of adverse events was comparable among TT, TL diuretics, and other antihypertensive therapy. Our data suggest that the best available evidence seems to favor TL diuretics as the drug of choice when thiazide treatment is considered for hypertension.
-
4.
Outcomes of drug-based and surgical treatments for primary aldosteronism.
Steichen, O, Lorthioir, A, Zinzindohoue, F, Plouin, PF, Amar, L
Advances in chronic kidney disease. 2015;(3):196-203
-
-
Free full text
-
Abstract
Treatments for primary aldosteronism (PA) aim to correct or prevent the deleterious consequences of hyperaldosteronism: hypertension, hypokalemia, and direct target organ damage. Patients with unilateral PA considered fit for surgery can undergo laparoscopic adrenalectomy, which significantly decreases blood pressure (BP) and medications in most cases and cures hypertension in about 40%. Mineralocorticoid receptor antagonists (MRA) are used to treat patients with bilateral PA and those with unilateral PA if surgery is not possible or not desired. Spironolactone is more potent than eplerenone, but high doses are poorly tolerated in men. MRA can be replaced or complemented with epithelial sodium channel blockers, such as amiloride. Thiazide diuretics and calcium channel blockers are used when the first-line drugs are insufficient to control BP. Dietary sodium restriction should be implemented in all cases because the deleterious consequences of hyperaldosteronism are dependent on salt loading. Several studies comparing the results of surgery and MRA have reported no differences in terms of BP, serum potassium concentration, or cardiovascular and kidney outcomes, although the benefits of treatment tend to be observed sooner with surgery. Patients with PA display relative glomerular hyperfiltration, which is reversed by specific treatment, revealing CKD in 30% of patients. However, further kidney damage is lessened by the treatment of PA.
-
5.
Clinical challenges in diagnosing and managing adult hypertension.
Handler, J
Cleveland Clinic journal of medicine. 2015;(12 Suppl 2):S36-41
Abstract
Although there is still no consensus on how to diagnose hypertension, opinion is moving toward incorporating out-of-office blood pressure measurements into the process. The SPRINT trial poses potential opportunities and challenges. Simplified antihypertensive drug regimens incorporating single pill combinations are very effective.
-
6.
Module 3: Using thiazide-type diuretics in African Americans with hypertension.
Wright, JT
The Journal of family practice. 2012;(8 Suppl):S20-2; quiz S31
-
7.
Thiazide and thiazide-like diuretics: an opportunity to reduce blood pressure in patients with advanced kidney disease.
Karadsheh, F, Weir, MR
Current hypertension reports. 2012;(5):416-20
Abstract
Thiazide and thiazide-like diuretics have been widely used as blood pressure-lowering agents for more than 5 decades. However, their use in patients with advanced chronic kidney disease has been limited and often discouraged. The exact mechanism of how thiazide and thiazide-like diuretics lower blood pressures is still in question. Emerging evidence suggests that thiazides and thiazide-like diuretics are effective as blood pressure-lowering drugs in patients with advanced chronic kidney disease. Review of the literature suggests that physicians should not discard thiazide and thiazide-like diuretics as options for blood pressure management in patients with chronic advanced kidney disease.
-
8.
Thiazide diuretics as chronic antihypertensive therapy in patients with severe renal disease--is there a role in the absence of diuresis?
Chan, CY, Peterson, EJ, Ng, TM
The Annals of pharmacotherapy. 2012;(11):1554-8
Abstract
OBJECTIVE To determine whether thiazides have a chronic antihypertensive effect, in the absence of diuresis, in patients with severe renal disease (creatinine clearance <30 mL/min) or in those receiving dialysis. DATA SOURCES A search was performed in PubMed, CENTRAL, and International Pharmaceutical Abstracts, using MeSH terms and/or key words. MeSH terms included kidney failure, chronic and exploded terms hydrochlorothiazide, renal dialysis, and thiazides. Key words included thiazide*, hydrochlorothiazide, chlorothiazide, chlorthalidone, indapamide, metolazone, methyclothiazide, bendroflumethiazide, hemodialysis, dialysis, kidney failure, renal failure, renal insufficiency, hypertension, vasodilation, vascular, and diuretics. STUDY SELECTION AND DATA EXTRACTION All relevant English-language publications were evaluated. Studies evaluating the efficacy of thiazides in renal insufficiency or dialysis were limited to those that included blood pressure measurements. Studies were included only if treatment duration was at least 4 weeks to evaluate chronic antihypertensive effects. DATA SYNTHESIS Thiazide diuretics are associated with a chronic reduction in peripheral vascular resistance secondary to a purported vasodilatory effect. However, few clinical studies have evaluated the chronic antihypertensive efficacy of thiazide and thiazide-like diuretics in patients with severe renal disease or those on dialysis. Agents studied include hydrochlorothiazide, chlorothiazide, indapamide, and metolazone, with results varying by drug and patient population. Hydrochlorothiazide 25-200 mg daily, chlorothiazide 500 mg twice daily, and indapamide 2.5 mg daily provided long-term blood pressure reduction in patients with severe renal disease who were not on dialysis. In studies involving patients on dialysis, hydrochlorothiazide 50 mg daily and metolazone 5 mg daily did not affect blood pressure; however, 1 study suggested that indapamide 2.5 mg daily may confer an antihypertensive effect. All studies were small (≤12 subjects) and had methodological limitations. CONCLUSIONS Thiazide diuretics may decrease peripheral vascular resistance independent of natriuresis. However, because current clinical data are inconclusive as to the efficacy of these agents at chronically lowering blood pressure in patients with severe renal disease or in those on dialysis, thiazide diuretics cannot be routinely recommended for this indication.
-
9.
Module 2: Rethinking the role of thiazide-type diuretics in the management of hypertension: which diuretic is best?
Cushman, WC
The Journal of family practice. 2012;(8 Suppl):S15-9; quiz S29
-
10.
[Effects of drugs for lifestyle-related diseases on bone metabolism].
Takeuchi, Y
Clinical calcium. 2011;(5):661-7
Abstract
Accumulating evidence indicates several drugs for lifestyle-related diseases are involved in bone metabolism. Drugs that might reduce fracture incidence are statins, β-blockers and thiazide diuretics, and those that might increase fractures are thiazolidinediones and loop diuretics. It is yet controversial whether ACE inhibitors, angiotensin receptor- II blockers and aldosterone receptor antagonists are indeed involved in the increase or the decrease in fracture incidence.