CONSULT ROUNDS

Hypertension management, a mechanist approach
Managing BP is something we all learned in medical school and nephrologist have become front runners in HTN management now.  An understanding of risk factors and mechanisms is very essential. That is what we discussed on a difficult HTN case yesterday.

Key Points:
1. Choosing medications based on age, sex and race is an appropriate along with co morbidities. Its reasonably studied that certain medications work better in certain races and not in some.  Adding and choosing BP regimens based on what other diseases the patient has is also a good point
2. Mechanism approach of treating HTN is becoming more and more popular but doesn't have that much evidence basis for it. But it makes sense pathophysiologically. Three mechanism exists: RENIN mediated, CATECHOLAMINE mediated and finally VOLUME mediated.
Most of your medications fall in any of those categories and if identified by history, physical and lab evals, one can choose the right kind of medication for treating the HTN.

For more interests in this subject, please read the AJH 2001;14 by John Laragh.