From the Guidelines
Elevated blood pressure is indeed a common concern in African medical patients, particularly those who have undergone total thyroidectomy, due to their increased susceptibility to hypertension. This susceptibility is attributed to physiological differences, including a suppressed renin-angiotensin-aldosterone system (RAAS), altered renal sodium handling, increased cardiovascular reactivity, and early vascular aging, as noted in the 2020 international society of hypertension global hypertension practice guidelines 1.
Key Considerations
- African patients, whether residing in Africa or elsewhere, tend to develop hypertension and associated organ damage at younger ages, with a higher frequency of resistant and nighttime hypertension, and a higher risk of kidney disease, stroke, heart failure, and mortality than other ethnic groups 1.
- The management of hypertension in these patients should prioritize lifestyle modification, focusing on salt restriction, increased intake of vegetables and fruits (potassium intake), weight management, and reducing alcohol intake, as recommended by the guidelines 1.
- First-line pharmacological therapy is recommended as a single pill combination, including a thiazide-like diuretic plus a calcium channel blocker (CCB) or CCB plus an angiotensin receptor blocker (ARB), with ARBs potentially being preferred over ACE inhibitors due to a lower risk of angioedema in black patients 1.
Clinical Implications
- Regular monitoring of blood pressure is crucial in African patients post-thyroidectomy, with the consideration of adding antihypertensive medications if necessary.
- The choice of antihypertensive medication should be tailored to the individual patient's needs, taking into account their specific risk factors and potential side effects.
- Given the increased risk of cardiovascular complications in African patients with hypertension, aggressive management of blood pressure, along with other modifiable risk factors, is essential to improve outcomes and reduce morbidity and mortality.
From the Research
Elevated Blood Pressure in African Medical Patients with Total Thyroidectomy
- There is no direct evidence in the provided studies to suggest that elevated blood pressure is often seen in African medical patients with total thyroidectomy 2, 3, 4, 5, 6.
- The studies primarily focus on thyroid hormone replacement therapy after thyroid surgery, management of hypertensive patients undergoing surgery, and treatment of acute postoperative hypertension.
- However, it is mentioned that hypertension is highly prevalent in patients presenting for surgery, and its impact on surgical outcome is still debated 5.
- The management of patients with hypertensive disease requires an individualized and pathophysiology-based approach to control blood pressure, especially in the perioperative period 5.
- Additionally, the treatment of acute postoperative hypertension should consider reversible or treatable causes of hypertension, such as pain, anxiety, hypothermia, and hypoxemia, before implementing antihypertensive therapy 6.