ABSTRACT
PURPOSE OF REVIEW: Several recent trials and observational studies have identified critical areas that can help to improve the management and measurement of blood pressure in patients with hypertension. RECENT FINDINGS: High-quality trial evidence supports intensive SBP lowering to 110-130âmmHg in older patients, potassium- based salt substitution in patients without chronic kidney disease, and chlorthalidone for the management of hypertension in patients with chronic kidney disease. In addition, population-based studies indicate enormous underdiagnosis of primary aldosteronism as well as greater sustained intensification of antihypertensive therapy in older patients by maximizing medication dosage rather than adding new agents. The prevalence of hypertension is stable worldwide, though is generally improving in high-income countries and worsening in low-income countries. Furthermore, although cuffless blood pressure devices have the potential to improve access to blood pressure measurement, they have not yet demonstrated sufficient accuracy for clinical use. SUMMARY: Growing evidence supports intensive blood pressure lowering, sodium reduction, targeted antihypertensive treatment and appropriate screening for secondary hypertension to optimize blood pressure control and reduce the risk of target organ damage from hypertension. Future studies are needed to identify ways to improve our ability to implement these findings in routine clinical practice.
Subject(s)
Hypertension , Renal Insufficiency, Chronic , Aged , Antihypertensive Agents/adverse effects , Antihypertensive Agents/therapeutic use , Blood Pressure , Blood Pressure Determination , Female , Humans , Hypertension/diagnosis , Hypertension/drug therapy , Hypertension/epidemiology , Male , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/drug therapy , Renal Insufficiency, Chronic/epidemiologyABSTRACT
A 63-year-old man with past history of multiple myeloma recently started on a regimen of daratumumab, carfilzomib, and dexamethasone was referred to our emergency department for a rapidly rising serum creatinine as high as 10 mg/dL. He complained of fatigue, nausea, and poor appetite. Exam revealed hypertension, but no edema or rales. Labs were consistent with AKI without hypercalcemia or evidence of hemolysis or tumor lysis. Urinalysis and urine sediment were bland without proteinuria, hematuria, or pyuria. Initial concern was for hypovolemia or myeloma cast nephropathy. POCUS revealed no overt evidence of volume overload or depletion, instead revealing bilateral hydronephrosis. Bilateral percutaneous nephrostomies were placed with resolution of the AKI. Ultimately, referral imaging revealed interval progression of bulky retroperitoneal extramedullary plasmacytomas compressing the ureters bilaterally related to the underlying multiple myeloma.
