All sorts of factors (efficacy at preventing MI, side-effect profile, cost) come into play when considering the choice of antihypertensive, but we now have a new one – effectiveness of prevention of heart failure. Surprisingly, diuretics were the most effective antihypertensives at preventing long-term CCF, leaving ACE inhibitors in second place, possibly joined there by AIIRAs (this wasn’t clear). CCBs came in third and beta-blockers, while they may be great at treating heart failure, work no better than placebo in preventing it. Looking at that list, I can’t say that it’s likely to produce any great changes in the current batting order – might possibly make ACEs a better second choice for the over-55s than has hitherto been thought, but nothing very conclusive. Phew. We can stick with trying to remember the usual ABCD format.
According to an article on leg ulcers, any patient with a venous ulcer should undergo duplex ultrasonography. Something tells me this ain’t gonna happen in practice. But good news for those of us who’ve had the tedious job of unwrapping bandages to look at leg ulcers and then having to figure out how the hell to wrap them again; it seems compression with stockings may be on the road to replacing compression with bandages, as it’s more effective, less painful, and easier to use.