The Cardiometabolic Think Tank was convened on June 20, 2014, in Washington, DC, as a "call to action" activity focused on defining new patient care models and approaches to address contemporary issues of cardiometabolic risk and disease. Individual experts representing >20 professional organizations participated in this roundtable discussion. The Think Tank consensus was that the metabolic syndrome (MetS) is a complex pathophysiological state comprised of a cluster of clinically measured and typically unmeasured risk factors, is progressive in its course, and is associated with serious and extensive comorbidity, but tends to be clinically under-recognized. The ideal patient care model for MetS must accurately identify those at risk before MetS develops and must recognize subtypes and stages of MetS to more effectively direct prevention and therapies. This new MetS care model introduces both affirmed and emerging concepts that will require consensus development, validation, and optimization in the future.
Hypertension is a leading risk factor for cardiovascular disease, which includes coronary heart disease, heart failure and stroke. This article examines the possible benefits and potential pitfalls of utilizing race-based categories for antihypertensive therapy. Although the use of race and ethnicity to guide antihypertensive treatment is fraught with difficulty and is, to a large extent, inadequate, there may be benefit in recognizing specific aspects of race and ethnicity when approaching patients with hypertension. Evidence from clinical trials, including drug efficacy and safety comparisons and cardiovascular outcomes, has demonstrated some differences based on race/ethnicity. American federal standards strongly encourage capturing data on race/ethnicity, and most of the current data are available for self-described African-Americans. International studies increasingly identify race/ethnicity, although the data are not as robust as in US trials. Current guidelines recommend thiazide diuretics and/or long-acting calcium channel blockers as initial treatment for Blacks, although medications for compelling indications agents should be prescribed, regardless of race/ethnicity.
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