Aalok Patel

Prevalence of Resistant Hypertension and Eligibility for Catheter-Based Renal Denervation in Hypertensive Outpatients

BACKGROUND Studies of endovascular renal denervation (RDN) have demonstrated significant blood pressure reduction in eligible patients with resistant hypertension. These trials have used stringent inclusion and exclusion criteria in patient enrollment, potentially selecting for a small subset of patients with resistant hypertension. In this study, we examined the changes in estimated prevalence of resistant hypertension when using increasingly stringent definitions of resistant hypertension in a fixed population and assessed the generalizability of RDN when applying study criteria to a community-based hypertensive population. METHODS A retrospective chart review was done of hypertensive outpatients. Four increasingly stringent interpretations of the American Heart Association definition of resistant hypertension were used to calculate prevalence estimates. Patients eligible for RDN were identified using criteria from SYMPLICITY HTN-3. Demographic and clinical characteristics were compared. RESULTS We identified 1,756 hypertensive outpatients; 55.0% were male, 53.9% were white, and subjects had a mean age of 66.6 ± 12.5 years and a body mass index (BMI) of 30.1 ± 10.7 kg/m(2). Only 14 (0.8%) were eligible for RDN. Among these patients, 10 (71.4%) were female and all were black, with a mean age of 69.9 ± 8.8 and BMI of 35.7 ± 6.6. Congestive heart failure was more common in patients eligible for RDN. CONCLUSIONS Patients eligible for RDN based on published studies represent an exceedingly small proportion of the total hypertensive population. Further studies are necessary to determine if the benefits of RDN can be generalized to a broader range of hypertensive patients than those included in previous trials.

Hypertriglyceridemia-induced acute pancreatitis treatment with insutin and heparin.

Mifepristone received an orphan drug designation by the FDA in 2007 and by European Commission in 2009 also for the treatment of Cushing’s syndrome. In Feb 2012, US FDA has approved it to control hyperglycemia in adults with endogenous Cushing’s syndrome. This drug has been approved for use in patients with endogenous Cushing’s who have type 2 diabetes or glucose intolerance, and are not candidates for surgery or who have not responded to prior surgery. The FDA determined that a Risk Evaluation and Mitigation Strategy was not necessary for mifepristone to ensure that the benefits outweigh the risks for patients with endogenous Cushing’s syndrome. Since there are no other approved medical therapies for this debilitating form of Cushing’s syndrome, it was thought that very sick patients would suffer if impediments to access were imposed.