Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Jun 2021
[Update on treatment resistant hypertension and secondary hypertension].
Resistant hypertension (RH) is defined in patients who do not meet their blood pressure targets despite the daily intake of three antihypertensive drugs in maximally tolerated dosages. This triple treatment should comprise (1) an angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB), (2) a calcium channel blocker and (3) a diuretic. RH should also be diagnosed in patients on four or more antihypertensive drug classes. ⋯ In most patients on triple treatment (ACE-I or ARB plus calcium channel blocker plus diuretic), mineralocorticoid receptor antagonists (MRA) should be the next treatment choice. As MRA may be associated with hyperkalemia (particularly in patients with chronic kidney disease), the concurrent use of potassium-lowering agents such as patiromer may allow a safe long-term treatment. In contrast, novel interventional treatment options in RH such as renal denervation are still controversially discussed.
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Treating sleep disorders is a challenge in individuals with dementia. A precondition for treatment success is thorough diagnostics of sleep disorders. ⋯ Drugs for the treatment of a sleep disorder should only be prescribed with a clear indication and prolongation of prescription should regularly be checked. The active search for and the treatment of sleep disorders should always be performed in individuals with dementia.
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Changes of lifestyle have a substantial effect on stroke prevention, especially in high-risk patients. Maintaining a healthier lifestyle can have greater effects than most pharmacological therapies of cardiovascular prevention. ⋯ Despite the abundance of observational data and meta-analyses assessing the association of different lifestyle changes and stroke risk, the literature frequently lacks evidence from randomized controlled clinical trial. This article will provide an overview of various forms of lifestyle changes and summarize their potential to modify the risk of stroke.
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The use of combined hormonal contraceptives (CHC) is a well-established risk factor for venous thromboembolism (VTE). The VTE risk depends on the specific combination of oestrogen and gestagen components. Progestin-only contraceptives with the exception of depot medroxyprogesterone acetate are not associated with a significant VTE risk and can therefore be offered to women with known thrombophilia or a prior VTE. ⋯ The risk of recurrence is low in women with hormone-associated VTE. Anticoagulation is therefore in general discontinued after 3-6 months. Thromboprophylaxis with low molecular heparin is recommended for women with prior hormone-associated VTE during pregnancy and the postpartum period.
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Lung involvement is one of the most frequent organ manifestation in rheumatic diseases (CTD-ILD). Especially patients with rheumatoid arthritis, systemic sclerosis, and idiopathic inflammatory myopathies are affected. Interstitial lung diseases (ILD) are still associated with significant morbidity and mortality. ⋯ Methotrexate is probably not a significant cause of lung disease in rheumatoid arthritis but might even delay the presentation of interstitial lung disease (ILD). Tocilizumab could be a treatment option in SSc-ILD, despite the limitations of the current studies. For Systemic Sclerosis-ILD (SSc-ILD) and progressive fibrosing ILD, antifibrotic therapy with nintedanib is now approved.