Impact of age, race, and obesity on hypertensive mechanisms and therapy

Article Abstract:

Essential hypertension is high blood pressure for which no definitive cause can be found. In such cases, the therapeutic strategy is to reduce blood pressure through interaction with blood pressure regulatory systems that are common to all individuals (rather than reversing the specific defect, which remains unknown). Historically, an approach known as stepped-care therapy has been used, which begins with the administration of relatively benign (though often ineffective) treatments such as diuretics, and mandates the administration of increasingly potent (and increasingly dangerous) antihypertensive drugs. Since there are recognized differences among groups of hypertensive patients that are reflected in their degrees of responsiveness to medications, it makes sense to use these differences in formulating the most effective treatment regimen. For example, hypertension among blacks is more prevalent, of earlier onset and worse prognosis, and exhibits a distinct hemodynamic (pertaining to the patterns of blood flow) profile compared with whites. The reasons for this are not known, but most likely relate to genetic factors and psychosocial stresses. Calcium antagonists (drugs that reduce blood pressure by blocking the entry of calcium into the muscle tissue of the blood vessels, interfering with their constriction) are particularly well suited as monotherapy (or as the primary therapy in a multi-drug regimen) for most black patients. Elderly hypertensive patients are also often best treated with calcium antagonists. In contrast, obese patients have a dramatically different pattern of symptoms resulting from (or perhaps involved in the causation of) hypertension; low-dose diuretics are the initial therapy of choice for such patients, followed by beta adrenergic receptor blocking drugs (beta blockers). In the small number of young hypertensive patients, beta blockers are the preferred initial therapy. In all cases, the characteristics of the patient population from which an individual patient is drawn should serve as a guide in determining the drug therapy that will provide the safest, most efficacious hypertension treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hypertension, Demographic aspects, Drug therapy

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Infectious complications among patients receiving home intravenous therapy with peripheral, central, or peripherally placed central venous catheters

Article Abstract:

A central venous catheter is a thin tube that is inserted into a vein so that medication or nutrients can be added to the blood. These types of catheters can be used for giving infusions to patients at home. This is called home intravenous infusion therapy, and it is becoming a popular method of treating patients with infections, malnutrition and chronic pain. However, central venous catheters can cause several different types of complications including bacteremia (the presence of bacteria in the blood), phlebitis (vein inflammation), pain or tenderness around the area where the catheter is inserted, and thrombosis (the formation of blood clots). This article describes the results of a study designed to identify complications resulting from catheterization in 300 patients receiving infusion therapy at home. Seventy-six of the patients had central catheters that were inserted into a peripheral vein (PICCs), 127 patients had centrally inserted catheters, and 97 patients had peripheral catheters. The average age of the patients was 39 years. Osteomyelitis (bone marrow inflammation) was the most common condition being treated, followed by malnutrition, lung infections and chronic pain. The average length of home therapy was 34 days. During the 29-month study period, there were only six cases of bacteremia caused by the catheters. However, it should be mentioned that the patients who developed bacteremia required catheterization for almost twice as long as the other patients and had more severe illnesses. Fifteen patients developed complications at the site where the catheter was inserted. Of the patients who were treated with PICCs, 16 developed blood clots and 11 developed phlebitis. The results of this study indicate that home therapy is successful and has a low rate of complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Evaluation, Complications and side effects, Intravenous catheterization, Home care, Intravenous therapy

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