In nondiabetic patients with hypertensive CKD treated with ACEIs, the risk of hyperkalemia is small, particularly if baseline and follow-up GFR is higher than 40 mL/min/1.73 m(2). Including a diuretic in the regimen may markedly reduce risk of hyperkalemia.

The purpose of the study was to determine the feasibility of international teleradiology, utilizing day-night time differences, for online interpretation of overnight computed tomography (CT) studies. One hundred and two consecutive Emergency Room patients who underwent CT examinations between the hours of 11 pm and 7 am were enrolled. All age groups and study types were included. CT studies were transmitted from the in-hospital PACS system (Kodak, Fremont, Calif.) to a web-based server (Medweb, San Francisco, Calif.). A radiologist in Bangalore, India, working an 8 amto 4 pm day shift, downloaded and reviewed the studies on a desktop PC using a 128-kbps internet connection at 10-20:1 wavelet compression and generated a report. The report was then uploaded to the server, noting the time at upload. Each study report was compared with the official in-house diagnostic report and concordance assessed on a three-point scale. Mean download time was 8.14 s per image. For head CT reports ( n=47), the mean turnaround time for a final transcribed report was 39.5 min. For abdomen/pelvis CT reports ( n=48) the mean turnaround time was 84.4 min. Out of 106 cases, there was discordance between the clinical diagnostic report and the study report in 20 (19%); however, on subsequent review the teleradiology report was found to be correct in 13 of these. Day-night time differences across the globe can be utilized to provide overnight emergency radiology coverage using web-based teleradiology. Scan download and report upload times are within acceptable limits.

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Midway into the first decade of the 21st century, evidence-based medicine has become the predominant methodology for the education and practice of medicine. In the ascent to this pre-eminent position, evidence-based medicine has challenged several methodologies through which medicine was taught and practiced throughout the 20th century, including the clinical anecdote, the concept that medicine is an art, the notion that the physician acts as the filter through which medical knowledge is individualized for the patient, and to some extent, the application of principles of pathophysiology to guide individual patient care. Indeed, it appears that in many cases, this mechanism-based approach to disease has been replaced by a broad strokes population-based approach based on outcomes research. However, as in the law, evidence is open to interpretation, varying opinion and nuance. Perhaps nowhere is this more evident than in the field of hypertension, which arguably can be credited with developing the field of evidence-based medicine with randomized clinical trials in the early 1960s and early adaptation and promotion of outcomes-based research, beginning with the first Joint National Committee report on prevention, detection, evaluation and treatment of high blood pressure in the 1970s. The purpose of this chapter is to review the evidence in the diagnosis and treatment of essential hypertension, focusing on the following areas. First, use of ambulatory and home blood pressure monitoring as diagnostic and prognostic tools; second, recent clinical trials in the treatment of essential hypertension that form the basis of evidence-based therapeutics; and third, presentation of the key features of the Joint National Committee (JNC) 7, which forms the current basis of treatment for essential hypertension.