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Gradman AH. J Am Coll Cardiol ; National Institute of Health and Clinical Excellence. Hypertension: clinical Management of Primary Hypertension in Adults.

General Audience of 13 June | Francis

London: NICE; Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: A systematic review and meta-analysis. Hypertension ; Pradhan A. Cardiovascular risk screening: Time for a wakeup call!. Heart India ; Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: A systematic review and network meta-analysis.

Ten Commandments of Good Health Part 2

JAMA Cardiol ; Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. Fixed-dose combinations improve medication compliance: A meta-analysis. Am J Med ; Users Online How to cite this article: Pradhan A, Vishwakarma P. Decoding the hypertension guidelines: The ten commandments.

1. I am the Lord your God: you shall not have strange gods before me

Meekness, strength, and not cowardice, not mediocrity. Blessed Pier Giorgio Frassati — he was a young man — used to say that one must live, not just get by. The life of young people is about moving forward, being restless, healthy restlessness, the capacity not to be content with a life without beauty, without colour. If young people are not hungry for an authentic life, I wonder, where will humanity end up?

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Where will humanity go with young people who are idle and not restless? The question of that man in the Gospel passage that we have heard is inside of each of us: how can we find life, life in abundance, happiness? Thus, what does he need in order to understand? How do we pass from youth to maturity? When we begin to accept our own limitations. How great it is to be men and women! How precious our existence is!

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Yet, there is a truth that, in the history of the last centuries, mankind has often rejected, with tragic consequences: the truth of our limitations. The Lord Jesus gives us the fulfilment; he came for this. That man had to come to the brink, where he had to take a decisive leap, where the possibility was presented to stop living for himself, for his own deeds, for his own goods and — precisely because he lacked a full life — to leave everything to follow the Lord.

Being able to choose between an original and a copy, who would choose the copy? Jesus does not offer surrogates, but true life, true love, true richness! Do not assume that all is well or that someone else will do it. Patients often do not volunteer adverse effects and clinicians often ignore reminders. The NNT should be just a starting point for clinicians: they give you a rough idea of the statistical likelihood of a particular treatment having some effect within a trial population or pre-specified subgroup.

Patients are right to find them hard to apply to themselves. For most symptomatic conditions, the NNT simply identifies the treatments that may be worth considering first. Cost as well as efficacy may be a consideration. Thereafter, it may require one or more trials of treatment to find the most effective drug. In some situations, such as neuropathic pain, it may be worth trying drugs with a relatively small statistical likelihood of benefit, if this offers the possibility of success when more likely agents have failed.

Before printing off a prescription, consider whether a non-drug intervention might be as, or more, effective.

Top 10 Commandments For A Healthy Heart

Do not use drugs as a shortcut because alternatives might take more time to explain or be harder to access. As a general rule when prescribing long-term drugs, it is best to use a single agent and use the lowest dose to start with. This usually provides the best balance between benefit and adverse effects.

If you do decide to uptitrate, discuss the marginal benefit in full with your patient. It is sometimes useful to use a combination of low-dose agents, for example, to reduce blood pressure. But be aware of potential harms and adverse interactions.


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Before you increase a dose or add another agent, make sure that you have given your initial treatment an adequate trial and that your patient is really taking it. Matt Burkes and Alec Logan, eds. London: Royal College of General Practitioners, National Center for Biotechnology Information , U. Br J Gen Pract. Author information Copyright and License information Disclaimer. E-mail: moc. This article has been cited by other articles in PMC.

Thou shalt have no aim except to help patients, according to the goals they wish to achieve When deciding on a treatment, the first diagnosis you need to reach is about the nature of the illness. Thou shalt always seek knowledge of the benefits, harms, and costs of treatment, and share this knowledge at all times Both health professionals and lay people tend to overestimate the benefits of treatments and underestimate their harms. Thou shalt, if all else fails or if the evidence is lacking, happily consider watchful waiting as an appropriate course of action The first commandment assumes that there will be two diagnoses in each consultation.

Thou shalt honour balanced sources of knowledge, but thou shalt keep thyself from all who may seek to deceive thee There is no single reliable, unbiased, and continuously updated source of knowledge about effective treatments that can be shared by patients and health professionals.

Thou shalt treat according to level of risk and not to level of risk factor Treating asymptomatic individuals to prevent future adverse events requires a different and longer process of information sharing than treating uncomplicated acute illness. Thou shalt not bow down to treatment targets designed by committees, for these are but graven images Traditionally, elevations of single risk factors such as blood pressure or lipid levels have been labelled hypertension or hyperlipidaemia, and individuals typically without symptoms have been urged to take drugs to reduce them to a certain level.

Honour thy older patients, for although they often have the highest risk, they may also have the highest risk of harm from treatment Age increases the risk of cardiovascular disease and most cancers. Thou shalt stop any treatment that is not of clear benefit and regularly reassess the need for all treatments and tests Always consider what drugs you can stop before considering those you can start. Thou shalt diligently try to find the best treatment for the individual, because different treatments work for different people The NNT should be just a starting point for clinicians: they give you a rough idea of the statistical likelihood of a particular treatment having some effect within a trial population or pre-specified subgroup.