Altering Overuse of Cardiac Telemetry in Non–Intensive Care Unit Settings by Hardwiring the Use of American Heart Association Guidelines

Abstract

cant decreases in blood pressure following renal denervation, but this sham-controlled study identified no such benefit.While these findings also may be influenced by patient selection, they should concern those inclined to recommend interventional treatment of resistant hypertension presumed due to renovascular causes.Keeping in mind that blood pressure reduction can only be considered a surrogate for "hard end points" such as death, myocardial infarction, stroke, congestive heart failure, and renal failure, we seem to be very far removed from any convincing evidence that renal artery interventions reduce cardiovascular or renal morbidity or mortality.With these issues in mind, where do we go from here?While awaiting further studies to investigate the possibility of a clinical benefit to renal artery interventions, we must focus on aggressive medical management of patients with refractory hypertension.We should not overlook the consistent evidence that sodium restriction, increased potassium intake, exercise and weight loss are associated with blood pressure reduction in patients with hypertension.Furthermore, the recent Eighth Joint National Committee guidelines 9 suggest that for nonblack patients, first-line therapy for hypertension should consist of 1 or a combination of thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.For black patients, firstline therapy should consist of thiazide diuretics and calcium channel blockers.Emphasis on the importance of lifestyle measures and medication compliance, and consideration of secondary causes such as sleep apnea, drug-induced hypertension, hypercortisolism, hyperaldosteronism, hyperthyroidism or hypothyroidism, or hyperparathyroidism is warranted in patients with resistant hypertension.Focus on proven therapies while we await more concrete data supporting the use of interventional procedures for resistant hypertension is the most reasonable approach, at least until the next big thing comes along.