Drug-Free Control of Hypertension
For decades, it has been commonly thought that routine therapy for high blood pressure began with the doctor’s prescription for anti-hypertensive drugs. This reflex response has made anti-hypertensive agents into a financial bonanza for drug companies.
But while drug therapy for high blood pressure is often effective, it has always existed alongside a variety of drug-free alternatives, including dietary modification, exercise and biofeedback.
Now, in two studies confirming the usefulness of non-drug treatment for hypertension, research teams have found new evidence that, for many people with high blood pressure, control may be achieved without drugs. One study, by researchers at Chicago’s Northwestern University Medical School, found that nutrition modification including weight loss, salt restriction and reducing alcohol intake often can equal control by drugs. The second study, from the Boston University School of Medicine, found many hypertensives can be taken off drugs for long periods even if they eventually must start using them again.
The findings, published in the Journal of the American Medical Assn., take note of widely reported side effects of many blood pressure control drugs. But there is also the more generalized reality in medicine that no drug is risk-free and any drug should be avoided whenever possible. In the Chicago study, which concluded that nutritional intervention can be a complete substitute for drugs in “a sizable proportion of hypertensives,” nutrition therapy patients lost an average of four pounds, while drug therapy subjects gained five pounds each. The nutrition therapy group smoked less, too.
BREAST CANCER ODDS
If you pay attention to what are presented as the odds of getting cancer, you may often have heard that one American woman in 11 will get breast cancer at some time during her life--a risk that seems frighteningly high. The 1-in-11 figure is common--finding its way into literature of the American Cancer Society, speeches by top federal government officials and a wide variety of consumer publications.
But this statement of risk is an overdrawn statistical manipulation, argues a University of Wisconsin cancer expert, who says the actual risk of getting breast cancer is far lower than the common figure implies and that perpetuating the high odds is a scare technique that is “almost like crying fire in a crowded theater.” Dr. Richard Love said the 1-in-11 misconception comes from calculations that statistically predict cancer risk--but based on the premise that all women will live to be 85, a supposition groundless even with today’s lengthening life spans. Because the risk of getting breast cancer markedly increases with age, the statistical assumption that women all live to be 85 skews the breast cancer odds monstrously.
The true chances, Love contended in a telephone interview and a letter to the editor in the Journal of the American Medical Assn., are about 1-in-1,000 for a 40-year-old woman, rising to 1-in-500 for a 60-year-old. The percentage risk during the 20-year span from 40 to 60 ranges from about 1.5% to 1.8%, he said. Love said he presumes the erroneous concept of breast cancer odds began with a misunderstanding about statistical calculations and, once having gotten into consumer hands, has simply remained.
CAESAREAN DISPUTE
The American Caesarean section delivery rate, under unremitting assault because it is continuing to increase with no indication any medical benefit is being derived, finds itself attacked anew in a study that compares deliveries in the United States and Ireland, finding no difference in the health of babies and their mothers.
The only significant difference between two groups of nearly 1,100 women each--all of them white and designated low-risk--was the Caesarean rate, which was more than twice as high in America as in Ireland. The study investigated the use of Caesarean section versus delivery facilitated by use of labor-easing drugs and other means in two similar hospitals.
The results were described by Dr. K. Harnett Sheehan of the University of South Florida College of Medicine in Tampa. Sheehan’s article appeared in the journal Lancet. American women, Sheehan said, underwent Caesarean births 12.3% of the time versus 5.6% for Irish women. The study specifically evaluated steps doctors took in response to symptoms of difficult labor, or dystocia.
Irish women had shorter labors, with only 8.1% of the Irish women experiencing labor longer than 12 hours, compared to 24.7% of the Americans. Far more of the Irish patients--10.7% versus 2.5%--than Americans showed symptoms of toxemia of pregnancy. But once the babies had been delivered, the two groups were nearly identical by two crucial criteria--birth weight and a standardized scoring system that measures a newborn’s heart rate, respiration, muscle tone, color and response to stimuli.
Sheehan concluded that the American medical system, in which financial incentives in the form of higher fees for Caesareans and stated concerns about malpractice liability have pushed up the Caesarean rate, may require reform in the wake of the new finding that at least a 50% reduction in the rate can be achieved with no risk to mothers or their babies.
POST-BYPASS EXERCISE
Exercise has been a staple of rehabilitation programs used after heart attacks for a decade or more, but a team of researchers at a Missouri hospital has taken it all a step further--finding that, for people who have had bypass surgery, in particular, highly intense aerobic exercise programs can speed and improve recovery.
While many post-bypass rehabilitation programs--especially those at busy centers that perform hundreds of such operations a year--routinely get post-operative patients moving vigorously, the finding underscores the value of exercise in new ways.
The study at Boon Hospital Center in Columbia, Mo., evaluated 31 bypass patients subjected to vigorous exercise programs of three sessions a week for 12 weeks, with each session lasting as long as an hour and including walking, jogging, rowing, stair climbing and aerobic movements of the arms and legs. Heart rates were reduced--a positive development--and patients generally were able to absorb high volumes of oxygen into their systems and realize many of the benefits of exercise seen in people in peak condition.
The clear conclusion, said the researchers in the journal Physician and Sportsmedicine, is that intense aerobic exercise is not only possible but highly desirable for bypass patients, beginning four to six weeks after their operations. Individual patients should consult with their physicians before undertaking such programs, however.
