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Keegan L. Complementary and alternative therapies and end-of-life care: Part 1. Altern Med Alert 2005;8(2):17-20.
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Part I of this series focused on hypertensive syndromes and clinical evaluation. This second and final part will cover antihypertensive medications and management of hypertension in specific disease processes.
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Although we have recently enjoyed the FDA approval of two agents for treatment of diabetic peripheral neuropathic pain (duloxetine [Cymbalta], pregabalin [Lyrica]), as yet we have no treatment for diabetic peripheral neuropathy itself.
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Several classes of pharmacological agents have demonstrated benefits in hypertensive patients with CAD, but most published studies have, of necessity, enrolled only patients with an elevated or borderline elevated blood pressure. Recent clinical trials have demonstrated benefits for both angiotensin-converting enzyme inhibitors and calcium channel blockers (in patients with coronary artery disease with relatively normal or borderline elevated blood pressures.
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These studies note that: . . .sub-clinical thyroid dysfunction is a common clinical problem with many controversial issues regarding screening, evaluation, and management.
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Moderate consumption of alcohol in women (about 1 drink daily) was associated with better cognitive scores at 2-year average follow-up in women aged 70 to 81 in the Nurses Health Study compared to nondrinkers, while excessive drinkers did not show any association with either improvement or decline.
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Sleep apnea can exacerbate diabetes, and Continuous Positive Airway Pressure (CPAP) can improve glucose control in diabetic patients with sleep apnea.
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Pregabalin has been approved for the management of neuropathic pain. It is the second drug to be approved for the treatment of painful diabetic neuropathy (after duloxetine) and the first drug to be approved for both diabetic neuropathy and postherpetic neuralgia.