Solution to resistant hypertension sometimes hides in plain sight

This issue also addresses stories about osteoarthritis, race and clinical algorithms, and follow-up care for thyroid cancers.


Resistant hypertension is difficult to treat by definition, but it can be easy to overlook one potential cause. Although primary aldosteronism is found in more than 20% of patients with this condition and screening in this group is recommended, uptake is generally low, with one recent study in U.S. veterans finding a rate below 2%. Part of the problem is that primary aldosteronism was once considered a rare disease, and physicians have not been taught to look for it. In our story, experts offer advice on testing and treatment.

Change is on the horizon for osteoarthritis, with new research indicating a role of inflammation in disease development and opening the door to more targeted treatments down the road. In the meantime, there are plenty of ways that internists can help manage osteoarthritis in their patients, including weight loss, exercise, and medications. Read our story for more, including why recent guidance has moved away from acetaminophen and toward topical and low-dose oral NSAIDs for pain relief.

COVID-19 has thrown a bright light on disparities in medicine over the past year, and a story reviews one area in particular: race and clinical algorithms. Widely used equations such as those for estimated glomerular filtration rate include race as a variable and change care for Black patients in ways that may not be clinically warranted. Physicians, medical students, and others have called for further study of this issue and have advocated for movement away from use of race in clinical equations. And while systemic change is in the works, individual physicians can raise their own awareness and discuss these issues with patients, experts said.

Our conference coverage this month is from ENDO2021, the annual meeting of the Endocrine Society, which was held virtually in March. A story reviews follow-up care in patients with thyroid cancer, focusing on optimal surveillance (worry, both by patients and physicians, plays a role) and offering tips on managing unhappiness in those receiving thyroid replacement therapies.

Also in this issue, a story examines the ethics of being a social media influencer as a physician, making the case for transparency and credentials, while a story discusses diagnosis and management of giant-cell arteritis. Read the inaugural column by ACP's new President for 2021-2022, George M. Abraham, MD, MPH, FACP.

How often do you see primary aldosteronism in your practice? What are your thoughts on use of race in algorithms? Let us know at acpinternist@acponline.org.