Lowering Blood Pressure Improves Diastolic Function, Regardless of Regimen
Reductions in blood pressure lead to improved diastolic function — regardless of the antihypertensive drugs used — reports a study in Lancet.
Researchers sought to determine whether the angiotensin-receptor blocker valsartan would be more effective than other antihypertensives at improving diastolic function. They randomized nearly 400 patients with hypertension and evidence of diastolic dysfunction to receive either the ARB or placebo. The patients also received other classes of antihypertensive agents to lower blood pressure to below 135/80 mm Hg.
After 38 weeks, tissue Doppler imaging showed improved diastolic function in both valsartan and placebo recipients, but there was no significant difference between the groups.
Authors of an accompanying commentary note that valsartan might have an advantage in patients with more advanced left ventricular remodeling. Nevertheless, they add, “the good news is that lowering blood pressure improves diastolic function, irrespective of the antihypertensive regimen used
Stroke Risk Doubles Within 5 Years After Diabetes Diagnosis
The risk for stroke is twice as high in patients with newly diagnosed diabetes as in the general population, according to a study in Stroke.
Using health databases of a Canadian province, researchers identified some 12,200 adults aged 30 and older with recent diagnoses of type 2 diabetes. During a mean follow-up of about 5 years, 9.1% of the patients had hospital admissions with a stroke-related diagnosis. The rate ratio for stroke was 2.1 for diabetes patients, compared with the general population.
The authors write that their results “will help to dispel the notion that macrovascular consequences of diabetes occur only in the long term” and may motivate “both patients and providers to aggressively control cardiovascular risk factors soon after diagnosis.”
Weight Management Program Benefits Overweight Children
A family-based program for weight management in pediatric obesity promotes sustained improvements in BMI and insulin resistance, according to a JAMA report.
Researchers compared the Bright Bodies weight management program with usual care in some 175 overweight children aged 8 through 16 who were attending a pediatric obesity clinic. Children in the intervention group, along with their adult caregiver, attended exercise classes twice a week for the first 6 months, and then biweekly for another 6 months. (They also attended behavior modification sessions, although less frequently.) Children in the usual-care group, also accompanied by a caregiver, received diet and exercise counseling at 6-month intervals.
At 6 and 12 months, changes in body weight, BMI, percentage of body fat, total cholesterol, and insulin resistance all significantly favored the intervention group.
The authors attribute the program’s success, in part, to the frequency of contact between families and staff, but they caution that “the expense incurred in operating such a program is substantial.”
Epilepsy Doubles Suicide Risk
Epilepsy doubles the risk for suicide, according to a large case-control study published early online in Lancet Neurology.
Danish researchers identified some 450,000 people with data in five national health and socioeconomic registries. Even after differences in psychiatric history and socioeconomic status were taken into account, the risk for suicide among patients with epilepsy was twice that of people without epilepsy.
Overall, suicide risk was highest among those with both epilepsy and a history of psychiatric disease, particularly affective disorders. In addition, suicide risk was highest in the first 6 months after epilepsy diagnosis and decreased with increasing age, both among those with and those without psychiatric comorbidities.
patients with newly diagnosed epilepsy “require special attention” to identify and treat those at risk for suicide.
Middle Age Not Too Late to Lower Cardiac Risk
Adopting a healthy lifestyle after age 45 may confer cardiovascular and mortality benefits even just 4 years later, according to a study in the July edition of the American Journal of Medicine.
To study the origin and progression of atherosclerosis, researchers prospectively followed roughly 16,000 adults aged 45 to 64 at baseline. After 6 years, about 1000 had newly adopted an overall healthy lifestyle, defined as four behaviors: eating at least five fruits and vegetables daily, exercising at least 2.5 hours weekly, maintaining a BMI between 18.5 and 30, and not smoking. Some 11,000 were following three or fewer of these behaviors.
During the next 4 years, those who had newly adopted all four behaviors had a 40% reduction in all-cause mortality and a 35% reduction in cardiovascular events, compared with those who were following three or fewer healthy behaviors.
The authors conclude that adhering to a healthy lifestyle is “extremely worthwhile, and that middle-age is not too late to act.”
Self-Monitoring of Glucose in Type 2 Diabetes
Monitoring had only a minimal effect on glucose control and other measur.
Some patients with type 2 diabetes who do not use insulin nevertheless monitor their blood
glucose .routinely at home. To determine the effect of self-monitoring, U.K. researchers conducted this randomized trial in patients with reasonably eswell-controlled diabetes who were not taking insulin. A total of 453 adults (mean age, 66) were assigned to one of three groups: (1) usual care without home glucose monitoring; (2) usual care plus home blood glucose monitoring, with instructions to call the doctor for interpretations of results; or (3) the same as group 2 plus additional training in interpreting blood glucose results.
At baseline, the mean hemoglobin A1c level was about 7.5%. At 12 months, changes in hemoglobin A1c levels, adjusted for baseline measures, were not significantly different in the three groups. For nearly all other measures (weight, blood pressure, body-mass index), the differences were also not significant. Total cholesterol levels fell significantly more in group 3 than in groups 2 and 1 (by 15.4 mg/dL, vs. 8.5 mg/dL and 6.2 mg/dL). Significantly more mild hypoglycemic episodes occurred in groups 3 and 2 (43 and 33, vs. 14).
Comment: These patients with type 2 diabetes had fairly well-controlled blood glucose and were not using insulin. Monitoring blood glucose levels — with or without instruction in interpreting the results — had a minimal effect on glucose control (and on other measures). Based on this study, routine self-monitoring of glucose is unnecessary for such patients. However, for patients with less well-controlled diabetes in whom drug therapies are being adjusted, self-monitoring may have value.
One Soft Drink a Day Raises Risk for Metabolic Syndrome
Middle-aged people who drink just one soft drink a day have a substantially increased risk for metabolic syndrome, a Circulation study finds.
The results, from the offspring cohort of the Framingham Heart Study, were released early online. The study found that adults drinking one or more soft drinks a day had a 48% higher prevalence of metabolic syndrome than those who drank them infrequently. The incidence of the metabolic syndrome was similarly increased among the cohort over 4 years of follow-up.
The study found that both regular and diet soda appear to carry similar metabolic hazards. The authors suggested several possible explanations for the association, including the idea that consuming sweet drinks increases preferences for other sweetened items. They say that lowering the consumption of soft drinks “may be associated with a lowering of the burden of metabolic risk factors in adults.”
Renin Inhibitor + ARB Better Than Either Drug Alone at Lowering BP
A renin inhibitor and an angiotensin receptor blocker are more effective at lowering blood pressure when used in combination than alone, reports a Lancet study, but editorialists question the clinical value of this approach.
Industry-funded researchers randomized some 1800 patients with mean resting diastolic BP between 95 and 110 mm HG to receive aliskiren, valsartan, both drugs, or placebo. After 4 weeks, doses were titrated to the maximum.
After 8 weeks of treatment, patients receiving either drug had lower resting BP than those on placebo, and patients receiving both drugs had lower BP than those on monotherapy. Ambulatory diastolic BP, measured in some 350 patients, fell to a greater extent with combination therapy (mean reduction, 10.3) than with monotherapy (mean reduction, 7.1).
The editorialists discuss the risk for hyperkalemia with these agents and argue that the observed BP reductions are less than what one might expect from combining a renin inhibitor with a diuretic or a calcium-channel blocker, as guidelines recommend. They conclude that “because of the potential life-threatening side-effects … this concept of treatment is unlikely to make it to general practice or even to primary prevention in specialist care.”
Blood Pressure and Glycemic Control Key to Preventing Diabetic Retinopathy
Strict blood pressure and glycemic control are effective in reducing vision loss from diabetic retinopathy and remain “the cornerstone in the primary prevention” of the disorder, according to a review published in JAMA.
Researchers examined 41 studies with a minimum follow-up of 12 months and 3 meta-analyses.
The 10-year Diabetes Control and Complications Trial found that, over 6.5 years of follow-up, intensive glycemic control in patients with type 1 diabetes reduced the incidence of diabetic retinopathy by 76% and progression by 54%, compared with conventional treatment. Tight blood pressure control had a similar effect, with one U.K. study reporting a 34% reduction in progression after 9 years’ follow-up.
Head and Neck Tumors Seem Associated with HPV
A commentary in Cancer suggests that oropharyngeal cancers associated with human papillomavirus type 16 could be prevented by vaccinating adolescent boys, in addition to girls, against HPV.
The authors point to a “stagnation” in the rate of decline in the incidence of oropharyngeal cancer despite lower tobacco usage. They also cite the younger age at presentation of these cancers and the increasing prevalence of HPV-16 in tumor tissue samples.
It’s likely, they say, that the mode of viral transmission to oropharyngeal sites is through oral sex. They are concerned “that vaccination programs limited to females will only delay the potential benefit in prevention of [these] cancers, which typically occur in men.”