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President's Message - Apr 2014 - Aldosterone and Aldosterone Antagonists: Current and Future Directions

Written by President
Friday, 04 April 2014

Aldosterone receptor antagonists (ARAs) are gaining increasing importance in the management of patients with high blood pressure and heart failure. Ongoing research is exploring further therapeutic indications for this pharmacologic group. The molecular basis of aldosterone mechanism of action were defined many years ago and its pleotropic effects were identified. The following message reviews the physiology of aldosterone, its potential harmful effects, the current and possible future therapeutic potentials of ARAs.

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President's Message - Jan 2014 - Resistant Hypertension Revisited

Written by President
Tuesday, 31 December 2013

Resistant hypertension, through uncommon in routine daily practice and in general population, its prevalence is high in specialized hypertension clinics and in clinical trials. In ALLHAT, CONVINCEm LIFE and INSIGHT, blood pressure was not reduced to target levels of < 140/90 mmHg in 30 to 50% of patients. Resistant hypertension is defined as failure to achieve adequate blood pressure control within 3 months in spite of a concomitant use of three or more antihypertensive drugs including a diuretic. Another definition is blood pressure greater than 160/100 mmHg on two visits not less than 2 months apart in spite of triple antihypertensive therapy which should include diuretics, beta blockers, sympatholytic and a vasodialator, ACE- inhibitors, ARB or calcium antagonist.

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President's Message - October 2013 - Comments on Egyptian Guidelines

Written by President
Sunday, 29 September 2013

The Egyptian Hypertension Guidelines are in their final revision, and it is helped that the complete document will be available to the medical community before the end of this year (2013). The following comments address some of the possible differences between the Egyptian and other guidelines and briefly outline the reasons for such differences. I have to admit from the start the limitations of our guidelines which are mostly based on expert opinion and consensus. The critical question was how to adapt international evidence- based guidelines and results of randomized trials to our Egyptian circumstances. Guidelines written in developed countries may not be applicable to the Egyptian community. Simply we can not afford many of the detailed routine laboratory work-up and we can not afford expensive medication taken lifelong. On the other hand, Selecting a higher threshold for diagnosing hypertension (150/95 mmHg) in Egyptian guidelines, may not be acceptable by many, and will be criticized since it is not conforming with other guidelines, however, it will limit the number of patients falsely diagnosed as being hypertensive and avoid the use of lifelong unnecessary medications, such policy will definitely make the cost of management of hypertension within the reach of many developing countries.

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