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This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.
A 68-year-old accountant visits his physician. He was told a year earlier that his blood pressure was somewhat elevated and was advised to reduce salt intake and increase physical activity. Otherwise he has been in good health and has no history or signs of cardiovascular or renal disease. On physical examination, his blood pressure is 178/72 mm Hg, with no clinically significant
The Clinical Problem
Strategies and Evidence
Evaluation
Evidence Supporting Treatment of Isolated Systolic Hypertension
Management
Lifestyle Changes
Drug Treatment
Strategies for Improving Blood-Pressure Control
Guidelines
Areas of Uncertainty
Conclusions and Recommendations
Source Information
From the Department of Medicine, Boston University Medical Center, Boston.
Address reprint requests to Dr. Chobanian at the Department of Medicine, Boston University Medical Center, 650 Albany St., Boston, MA 02118, or at achob@bu.edu.
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