Thinking about this more...the notion that MRAs are the only way to protect from excess aldo seems illogical... Aldo itself is a necessary hormone. It's the excess thought to independently cause fibrosis (and hard to tease apart from high BP). I'm surprised this is promoted with trial evidence...
I was told the reason spiro wasnt first line was purely due to history and how early trials were done. I think it's a great class that works synergistically with other classes (and with fewer side effects at lower doses)
Can't wait!
Interesting. So much to learn!
And why not do mra/thz first? Why just mra alone? I guess that's the magic... If you get a good response upfront you use fewer agents. But if you dont, couldnt that imply secondary htn where additional classes might help?
Super cool.
Canada's doing awesome stuff!
Thank you! Are you aware of an ongoing trial testing this?
I agree with this. Although it's based on observational data (so far), using renin as a biomarker when medically treating PA is part of the endo society guideline. I titrate MRA until renin rises, then if needed utilize A/C/D. tinyurl.com/yksmf5y8
How prominent is AI in your scholarship?
Personally I feel like Journals should have AI disclosures for every article - since even literature searches often involve some degree of AI....but lines get really blurry about writing vs editing, data analysis vs management, etc...
I think MRA as firstline is right around the corner.
Yeah. Given how sensitive new thresholds are I think patients previously considered salt sensitive or with primary htn can more easily meet criteria...while a mra should be considered upfront, the addition of other agents makes sense from a BP management perspective to me at least
Yeah - I think I'm finding and treating milder cases now and not observing that magic response. But that said ASIs may upend a lot of "firstline" thinking pretty soon.
There's more evidence for firstline agents in general, but screening for PA was not nearly as common. I wonder about BP reduction itself beyond focusing on the renin response. I think multiclasses makes sense for BP control.
I'm seeing more spironolactone monotherapy for medical management of non-lateralizing PA. Any evidence for this practice? I confess my conservative thinking is to adhere to evidence-based practice with some firstline agents for BP management (vs maxing out spiro alone). Thoughts?
I think it's complicated. We did a quality improvement project around food insecurity and found that a number of people did not consistently use their entitlement for food
This produce prescription subsidy seemed to move A1c in the wrong direction among patients with diabetes. I think it demonstrates some of the precision required in nutrient selection to optimize cardiometabolic health.
jamanetwork.com/journals/jam...
Important trial showing benefits of multifaceted team approach for significantly reducing systolic blood pressure among patients with lower income.
pubmed.ncbi.nlm.nih.gov/41950472/
Check out this trial design, examining two FDA-cleared cuffless devices:
www.sciencedirect.com/science/arti...
Some similarities and differences with our WEAR-BP trial: clinicaltrials.gov/study/NCT066...
Excited to share this letter led by our brilliant @harvardmed.bsky.social student, Katie Gao, with reflections on @sethaberkowitz.bsky.social's seminal clinical trial.
Optimizing Food-Is-Medicine Programs for High Blood Pressure url: jamanetwork.com/journals/jam...
Great paper... I still feel like an OHTN definition that combines orthostatic change with a standing hypertension threshold is problematic for the field. Several studies have found orthostatic increase to be inversely associated with subclinical CVD. Standing hypertension can mask that.
Grateful to the @hsph.harvard.edu for this nice post about our recent trial!
hsph.harvard.edu/news/healthy...
More hypertension alert notifications on smart devices...would love to see the underlying testing parameters for this one!
www.bloomberg.com/news/article...
Delighted to discuss food is medicine with @tctmd.bsky.social along with @bunmiogungbe.bsky.social !
www.tctmd.com/news/gofresh...
Excited to read the @ahascience.bsky.social new dietary guidelines out today!
www.ahajournals.org/doi/10.1161/...
Prescription for the Pantry: How Home-Delivered Groceries are Transforming Heart Health in Underserved Communities | Pharmacy Times share.google/tPprJelSEdne...
#HotOffThePress
The Challenge of White-Coat Hypertension Screening
academic.oup.com/ajh/advance-...
Some nice coverage of our work by @gohealio.bsky.social . Thank you @nishantshah-md.bsky.social for the kind words on our trial!
www.healio.com/news/cardiol...
Congratulations to @spjuraschek.bsky.social and his team for their stellar gofreshrx study and it's results!!
