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Posts Tagged ‘jnc7’

  1. Do 64slice MDCT  in all patients who has  a coronary event and follow it up with catheter based CAG.
  2. Use liberally the new biochemical marker ,  serum  B-naturetic peptide (BNP) to diagnose cardiac failure in lieu of basal auscultation.
  3. Advice  cardiac resynchronisation therapy in all patients  who are in class 4 cardiac failure with a wide qrs complex .
  4. As it is may be considered a  crime to administer empirical  heparin, do ventilation perfusion scan in all cases with suspected pulmonary embolism.
  5. Do serial CPK MB and troponin levels in all patients with well  established  STEMI .
  6. Open up all occluded coronary arteries irrespective  of symptoms and muscle viability.
  7. Consider  ablation of pulmonary veins as an  initial strategy in  patients with recurrent idiopathic AF. If it is not feasible  atleast occlude their left atrial appendage with watch man  device.
  8. Never tell  your patients   the  truths  about the  diet , exercise &  lifestyle modification (That can  cure most of the early hypertension) . Instead encourage the  use of  newest ARBs  or even  try direct renin antoagonists   to treat all those patients in  stage 1 hypertension.
  9. Avoid regular heparin in acute coronary syndromes   as  it  is a disgrace to use it  in today’s world. Replace all prescription of heparin with  enoxaparine  or  still better ,  fondaparinux  whenever  possible.
  10. Finally never discharge  a  heftily  insured patient   until  he completes all the  cardiology investigations  that are available in your hospital  .

Coming soon :  10 more ways to  increase cost of cardiology care . . .beyond common man’s reach

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Diuretics are the most commonly prescribed anti hypertensive agents.Thiazide diuretics which  was introduced many decades ago ,  lost popularity  in recent years ,  again got a second life after  the publication of ALLHAT trial recently. Now diuretics has become the  the drug of first choice in almost any hypertension unless any specific contraindication.

The most commonly used thaizide is hydrochlorthiazide ,and chlorthalidone.The blood pressure reducing effect is so consistent and smooth , all the currently popular molecules like ACE inhibitors and ARBs come with a combination with thiazide. While every one is clear diuretics are  effective anti hypertensive agent How it does is not clear.

How does a diuretic reduce blood pressure?

A. The exact mechanism is not clear. May not be uniformly effective in all patients  with HT.

B . Salt sensitive HT respond well to diuretics.

C. Volume correction /free water clearance might be a factor

D. Direct effect on vascular smoth muscle documented.The sodium transporter is blocked and  hence   calcium : sodium exchange is prevented .This depletes  intracellular calcium  in vascular smooth muscle cells .Less calcium for actin myosin interaction and hence vasodilatation

E. Thiazides combine well with all other antihypertensive drugs (ACEI, ARB, Beata blockers, calcium blockers)

F. Loop diuretics  like frusemide  can never be  a good antihypertensive agent.

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