ABSTRACT
The implementation of guideline-directed medical therapy (GDMT) in heart failure (HF) has many challenges in real-world clinical practice. The consensus document is written considering the variability of the clinical presentation of HF patients. HF medical therapies need frequent dose adjustment during hospital admission or when patients develop electrolyte imbalance, acute kidney injury, and other acute illnesses. The paper describes clinical scenarios and graphs that will aid the managing physicians in decision-making for HF therapy optimization.
ABSTRACT
Background The prevalence of resistant hypertension in Saudi patients with type-2 diabetes mellitus (T2DM) has not been previously estimated. Therefore, our objective was to assess the prevalence and characteristics of resistant hypertensive patients with T2DM at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Methods This cross-sectional study included patients with hypertension and T2DM who presented to our center in 2018. We examined 1960 patients with T2DM during the study period; 809 were hypertensives. We compared T2DM patients with controlled hypertension versus resistant hypertension. Results The prevalence of resistant hypertension in patients with T2DM was 137/809 (16.93%). The mean age was 66.38±10.80 years, and females presented 56% of the study population (n= 451). Obstructive sleep apnea (OSA; OR: 2.60 [1.15- 5.87]; P=0.02) and ischemic heart disease (IHD; OR: 3.01 [2.04- 4.45]; PË0.001) were significantly associated with resistant hypertension. The most common medications used with resistant hypertension were calcium channel blockers (CCBs; 89.05%), ß-blockers (76.64%), and angiotensin-2 receptor blockers (ARBs; 62.77%). Conclusions Resistant hypertension in patients with T2DM is common in Saudi Arabia. Resistant hypertension could be associated with OSA and IHD. Further studies are required to evaluate the temporal relationship between resistant hypertension and risk factors.
