Clinical Diagnosis and Management of Hypertension Compared With the Joint National Committee 8 Panelists' Recommendations

Abstract

Background The panelists of the Joint National Committee recently published new recommendations for the management of hypertension. Our study aims to evaluate how current practice compares. Hypothesis Current practice likely deviates from the recent JNC 8 panelists' recommendations. Methods A survey was sent to cardiology providers at 3 academic medical centers: Mayo Clinic, Jacksonville, Florida; Mayo Clinic, Scottsdale, Arizona; and Mayo Clinic, Rochester, Minnesota. Providers were asked to select which blood‐pressure goal would be deemed appropriate in various cases based on individual practice in both the maintenance of patients already on therapy as well as threshold of when to initiate therapy. Comparisons with current recommendations were made, as well as geographic location and level of experience. Results A total of 251 survey requests were sent (May 2014), and 77 responses (30.7%) were received. Cardiologists tended not to practice according to the new guidelines, with most variation seen in patients age >60 years without comorbidities on active treatment. Providers' selection of initial pharmacologic agents in non–African American patients, African American patients, and patients with diabetes mellitus reflected congruency with guidelines. Conclusions Our study found that clinical practice does not correlate well with the new blood‐pressure goal recommendations published by the Joint National Committee 8 panelists, particularly in patients age >60 years. Practitioners are likely to follow the recommendations in regard to pharmacologic management.

High Plasma Levels of Gremlin‐1 and Macrophage Migration Inhibitory Factor, but Not Their Ratio, Indicate an Increased Risk for Acute Coronary Syndrome in Patients With Type 2 Diabetes Mellitus

“…Our findings suggest that Gremlin‐1/MIF ratio might serve as a new additional marker for the risk assessment in patients with CAD and ACS, but its impact in diabetic patients regarding the progression of CAD and the occurrence of acute cardiovascular events remains unclear. As patients with DM2 are at risk for developing adverse cardiovascular events such as MI or stroke, an additional evaluation of the Gremlin‐1/MIF ratio in their plasma might be helpful for the individual risk management in the clinical routine, along with consequent treatment of concomitant cardiovascular risk factors such as arterial hypertension and dyslipidemia, but larger randomized studies are needed to further clarify the relevance of the Gremlin‐1/MIF ratio in DM2.…”