- A 2002 meta-analysis by Lee Hooper of 11 trials of at least 6 months duration found a 1.1/0.6 mmHg reduction from a 35 mmol (810 mg) reduction in sodium intake.
- A broader meta-analysis published in JAMA in 1998 looked at 114 trials and found a reduction of 3.9/1.9 in hypertensive patients and 1.2/0.3 in normotensive participants.
- JNC 7 (PDF) recommends a sodium intake of 100 mmol (2.3 g) per day
- 2007 European Society of Hypertension (PDF) recommends reducing sodium intake to less than 85 mmol (2 g) per day
- American Diabetes Asociation recommends sodium restriction as part of lifestyle modification which can be attempted in cases of mild hypertension prior to drug therapy or in conjunction with drug therapy for more severe hypertension
- K/DOQI Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease recommends dietary intake of less than 2.3 g (100 mmol/d) of sodium for most patients with CKD and high blood pressure
- It is a randomised trial. Even though the current data comes from an observational extension of the original RCT, this does not change the fact that we are looking at two groups that were orignially randomized.
- This is a study which looks cardiovascular events rather than blood pressure or other intermediate outcomes.
- Decreased blood pressure of 5.5/3.0 mmHg
- Decreased in hypertensives 11.4/5.5 mmHg
- Maximal blood pressure response occurred after only 2 weeks
- Control group with no interventions
- Standard advice: 18 face-to-face meetings to go over weight loss, and strategies to reduce sodium and alcohol consumption
- Standard + DASH: 18 face-to-face meetings with the same contant as the standard group with additional counseling on adopting the DASH diet
I have a new patient that I inherited from a former colleague. She came to me with a letter from her ophthalmologist addressed to the patient that she was suppposed to give to her primary care doctor and nephrologist.
I am going to give you a copy of Harrison’s textbook to look for secondary causes of hypertension.
When the patient came in she didn’t have the book so I have no idea how to re-run her work-up of secondary hypertension (which had been done multiple times in the past).
One of my high volume referring doctors uses a lab which does not calculate the microalbumin to cr ratio. It always stops me in my tracks when I see the values.
- To convert microalbum and urine creatinine to the useful ratio first make sure both values are expressed as mg/L or mg/ml
- Divide the microalbumin concentration by the creatinine concentration
- Multiply the resulting ratio by 1,000 to get mg albumin over grams creatinine
Microalbumn urine 5.6 mg/dL
Creatinine urine 91.2 mg/dL
Dividing the albumin by cr gives: 0.061
Multiply that by 1,000 to get 61 mg albumin/g creatinine
Our two best selling games have been ranked and are currently ranked pretty highly on that hard to find list of paid apps. RetroDefense was #1 for a while and is currently around #12 with a perfect 5 star rating. Battle for Mars is currently #5 overall with a 4.5 star rating. Both of these games are selling for $4.99, which is on the upper end of the price range. Finally, both of these games have been featured by Google in the market app and on the Android website. So with all this in mind, here’s our daily Android sales for this August (these numbers include sales from our other two apps, but they barely register):
That’s a $62.39 daily average. Very difficult to buy the summer home at this rate.
Several studies have identified the overuse of daily lab testing and how certain interventions can effectively reduce tests ordered. A study by Miyakis et al. examined the effects of disclosing lab test costs on the frequency at which healthcare providers ordered these tests. 24,482 laboratory tests were ordered before the intervention (mean 2.96 tests/patient/day). Among those, roughly 70% were not considered to have contributed towards management of patients (mean avoidable 2.01 tests/patient/day). After costs of tests were disclosed, the avoidable tests/patient/day were significantly decreased (mean 1.58, p = 0.002), but containment of unnecessary ordering of tests gradually waned during the semester after the intervention. (1) A study by Kumwilaisak et al. examined how the implementation of formal guidelines effected how laboratory tests were ordered. 1,117 patients were enrolled. After the institution of the guidelines, the number of laboratory tests decreased by 37% (from 64,305 to 40,877). Furthermore, this result was still present at 1 year. (3)