South African Hypertension Practice Guideline 2014 : Review Article

Outcomes : Extensive data from many randomised; controlled trials have shown the benefit of treating hypertension (HTN). The target blood pressure (BP) for antihypertensive management is systolic 140 mmHg and diastolic 90 mmHg; with minimal or no drug side effects. Lower targets are no longer recommended. The reduction of BP in the elderly should be achieved gradually over one month. Co-existent cardiovascular (CV) risk factors should also be controlled. Benefits : Reduction in risk of stroke; cardiac failure; chronic kidney disease and coronary artery disease. Recommendations : Correct BP measurement procedure is described. Evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy are stipulated. Lifestyle modification and patient education are cornerstones of management. The major indications; precautions and contra-indications are listed for each antihypertensive drug recommended. Drug therapy for the patient with uncomplicated HTN is either mono- or combination therapy with a low-dose diuretic; calcium channel blocker (CCB) and an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB). Combination therapy should be considered ab initio if the BP is ? 160/100 mmHg. In black patients; either a diuretic and/or a CCB is recommended initially because the response rate is better compared to an ACEI. In resistant hypertension; add an alpha-blocker; spironolactone; vasodilator or ?-blocker

Anaemia and renal function in heart failure due to idiopathic dilated cardiomyopathy.

BACKGROUND: Anaemia and renal dysfunction are common in patients with heart failure (HF). Most studies involve western cohorts with ischaemic aetiology receiving treatment likely to impair renal function. AIMS: To investigate the frequency of anaemia and renal dysfunction and the relationship between the two within a cohort of 163 newly diagnosed Black African idiopathic cardiomyopathy patients prior to commencing HF treatments and compare those findings to those of western HF cohorts. METHODS: Single-centre retrospective analysis. Anaemia defined as haemoglobin concentration<13.0 g/dL for males (n=85) and <12 g/dL for females (n=78). Probable renal dysfunction defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m2, using serum creatinine concentrations. RESULTS: The mean age was 48+/-11 years, 52% were male. Overall, 13.5% of patients were anaemic and 11.8% had evidence of renal dysfunction, while 1.2% had both. Renal dysfunction was significantly more common in older patients (mean age 58+/-13 vs. 47+/-10 years: p<0.001). CONCLUSION: The frequency of anaemia and renal dysfunction in this cohort was lower than that reported in western HF cohorts. These data infer a more limited relationship between HF, anaemia and renal dysfunction in patients without atherothrombotic disease; hence extrapolation of HF data from the western world to other populations should be interpreted cautiously.