Clostridium difficile peritonitis in PD: Transmural migration or intestinal perforation?
Khan BSA, Reddy S, Zakhour S, Sallam O, and Shaban H. Clostridium difficile peritonitis in PD: Transmural migration or intestinal perforation? American Journal of Kidney Diseases 2020; 75(4):595-596.
Am J Kidney Dis
Diuretics are an important component of guideline-directed treatment of resistant hypertension. However, the ideal diuretic regimen has not been defined. We hypothesize that the BP response to a diuretic is dependent on the type of diuretic used. In this study, we aim to identify any differences in BP response between the most commonly prescribed diuretics: hydrochlorothiazide (HCTZ), chlorthalidone, spironolactone and loop diuretics. Data from clinic visits of adults referred to the Hypertension Specialty Clinic at the University of Alabama at Birmingham were analyzed. Fellows trained to follow the American Heart Association guidelines measured each office BP. Anti-hypertensive medications with dosing were captured at each clinic visit. The association between office BP and type of diuretic used was assessed using a mixed linear model, which accounted for multiple clinic visits per patient and allowed for covariate adjustment. The study population consisted of 386 patients with 1043 visits; 156 out of 386 (40%) patients were Black and 227 out of 386 (59%) were women. A typical patient was 61 years old and obese (median BMI 31 kg/m^2) with an initial BP of 154/83 mm Hg (mean) while taking 4 (median) classes of antihypertensive medications. Over the course of a median of 3 visits, the office BP dropped by 15.3 ± 25 mm Hg (mean ± std). After adjusting for age, sex, class of antihypertensive medication, and race, diuretic use and ACEi/ARB use were independently associated with office systolic BP (F value 11.6, p 0.0007 and F value 12.4, p 0.0005, respectively). When diuretics were further subcategorized as chlorthalidone, hydrochlorothiazide, loop diuretic, and spironolactone, only chlorthalidone and spironolactone were associated with office systolic BP (F value 27.5, p < 0.0001 and F value 8.9, p < 0.0029, respectively). In the adjusted model, an increase in chlorthalidone dose by 12.5mg is associated with a 4.13 mm Hg reduction in office systolic BP. In our hypertension specialty clinic, diuretic use was associated with BP reduction in the treatment of resistant hypertension. After covariate adjustment in a mixed linear model, chlorthalidone was identified as the principal diuretic responsible for blood pressure reduction. Loop diuretics and HCTZ were not associated with BP reductions.