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In the Clinic |


Matthew R. Weir, MD
[+] Article, Author, and Disclosure Information

CME Objective: To review current evidence for the screening and prevention, diagnosis, treatment, and practice improvement for hypertension.

Disclosures: Dr. Weir, ACP Contributing Author, has disclosed the following conflicts of interest: Consultancy: Amgen, Relypsa, Keryx, Sanofi, Novartis, Janssen, BMS, Otsuka, AbbVie, Sandoz. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1897.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.

With the assistance of additional physician writers, Annals of Internal Medicine editors develop In the Clinic using resources of the American College of Physicians, including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program).

Ann Intern Med. 2014;161(11):ITC1. doi:10.7326/0003-4819-161-11-201412020-01006
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This article has been corrected. The original version (PDF) is appended to this article as a Supplement.

This issue provides a clinical overview of Hypertension focusing on prevention, diagnosis, treatment, practice improvement, and patient information. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from ACP Smart Medicine and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult http://smartmedicine.acponline.org, http://mksap.acponline.org, and other resources referenced in each issue of In the Clinic.




Grahic Jump Location

Algorithm for treatment of hypertension. From reference 4. ACE = angiotensin-converting enzyme; ARB = angiotensin-receptor blocker; CCB = calcium-channel blocker; CKD = chronic kidney disease; DBP = diastolic blood pressure; SBP = systolic blood pressure.

Grahic Jump Location




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Pregnancy and Hypertension
Posted on August 25, 2015
Ashraf Uddin Chowdhury, MD
Central Police Hospital
Conflict of Interest: None Declared
Some antihypertensive drugs are absolutely contraindicated in pregnancy. Some are category C in pregnancy. Methyl dopa is not a very effective oral agent, and often fails to control high blood pressure in pregnancy. Which are the antihypertensive drugs are now recommended to use in pregnancy?
Calcium channel blockers; dihydropyridine (DHP-CCB) and non-dihydropyridine (non-DHP-CCB)
Posted on September 8, 2015
Gauranga Dhar
Bangladesh Institute of Family Medicine and Research
Conflict of Interest: None Declared
Very good review on hypertension. I have a little confusion on the paragraph “ACE inhibitors and ARBs combined with nonhydropyridine calcium-channel blockers”. Calcium channel blockers (CCBs) are usually divided in to two groups; dihydropyridine (DHP-CCB) and non-dihydropyridine (non-DHP-CCB). Did the author meant “non-dihydropyridine” as “nonhydropyridine”? If so, the paragraph describes amlodipine which is a good and very popular DHP-CCB. Amlodipine is a very good drug for both as monotherapy or in combination with ACE or ARB.
Although both DHP-CCBs and non-DHP-CCBs have similar mechanisms of action but their physiological effects differ. Because more prominent negative inotropic, chronotropic and dromotropic effects are found in non-DHP-CCBs (diltiazem or verapamil) in comparison to DHP-CCBs (amlodipine), this group (DHP-CCBs) is effectively used to manage hypertension and angina. I have still a question that what the author meant by “nonhydropyridine”?

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