Hypertension Treatment Studied
As many as 50 million Americans suffer from high blood pressure, a condition that places them at increased risk of stroke, heart problems and kidney disease. Yet many physicians do not adopt the aggressive approach to treating hypertension recommended by federal guidelines issued in 1977.
That lack of aggressiveness was further documented in a new study of Veterans Affairs hospitals published Wednesday in the New England Journal of Medicine. Although they examined only patients at the VA facilities, the researchers are confident that their results are representative of the medical profession as a whole.
A team from the VA and the Boston University School of Medicine studied 800 older male patients with diagnosed hypertension at five VA medical centers. The men, most of them white with an average age of 65, had typically suffered from hypertension for 12 years.
A full 40% of the patients had elevated blood pressures at the beginning of the study, even though they made an average of six hypertension-related medical visits each year. Despite that high incidence, however, their physicians changed therapies or initiated new therapies on only 6.7% of office visits. An aggressive physician, in contrast, would have changed therapy much more often.
And such changes are beneficial. At the end of the two-year study, those patients whose doctors had treated them aggressively saw a drop in their systolic blood pressure averaging 6.3 millimeters of mercury, while those getting the least aggressive therapy had an increase of 4.8 millimeters.
“Our study clearly demonstrates that physicians are not aggressively treating hypertension or taking the simple, necessary steps to reduce high blood pressure in a patient,” said the lead author, Dr. Dan R. Berlowitz of the VA New England Health Care System.
Quality of Life Drops After Node Surgery
Axillary lymph node dissection, a highly invasive procedure in which surgeons cut out the lymph nodes under a woman’s arms to look for cancer spread, is one of the most painful and depressing effects of breast cancer surgery and researchers should look for alternative ways to assess cancer spread, according to a new study.
Dr. Thomas Hack and his colleagues at the Toronto Hospital in Ontario surveyed 222 women who had undergone such lymph node dissections to determine their quality of life. They reported in Friday’s Journal of Clinical Oncology that, 33 months after their surgery, 72% of the women still experienced arm/shoulder pain, weakness or numbness and that 73% suffered an impaired range of arm motion. Most women with the problems rated their quality of life as relatively poor.
The authors recommended use of newer techniques, such as using tumor size as an indicator of spread. They also recommended “sentinal node biopsy,” in which a blue dye is used to identify the first lymph node that cancer cells could reach. Many studies have shown that if this lymph node is free of malignant cells, the cancer is unlikely to have spread.
Migraines Linked to Young Women’s Strokes
Young women who have a history of migraine headaches are 3.5 times more likely to suffer a stroke than those who do not, British researchers reported in Saturday’s British Medical Journal. Dr. Limmie Chang and her colleagues at the Imperial College School of Medicine in London found that the women further increased their risk if they smoked, had high blood pressure or used oral contraceptives.
In their study of 291 women ages 20 to 44 who had suffered a stroke, the team found that as many as 40% of strokes in women with a family history or personal history of migraines seemed to develop directly from a migraine attack. They were at a loss to explain the cause of the linkage, however.
Many Pregnant Women Exposed to Pesticides
A majority of pregnant California women are exposed to pesticides, but it is not clear yet whether that exposure increases the risk of birth defects, according to researchers from the California Birth Defects Monitoring Program. “Common sense dictates that pregnant women should minimize their exposure to pesticides and other potentially harmful substances,” noted State Health Director Kim Belshe.
The team reports in the January issue of Epidemiology that three out of every four pregnant women they studied had at least one exposure to pesticides during their pregnancy and 15% had three or more exposures. Only about 5% of the women had jobs involving pesticide exposure, however. Most were exposed during efforts to remove insect pests from the house or garden, and about 25% lived within a quarter-mile of agricultural crops where pesticides were used.
Slightly elevated risks of birth defects, about 1.5 times normal, were found for women who used pesticides in gardens or who lived near agricultural crops.
Genetic Defect May Hinder Weight Loss
Some people apparently have a genetic susceptibility that makes it hard for them to maintain a weight loss, Finnish researchers reported in the December Journal of Clinical Endocrinology and Metabolism. A team from the University of Kuopio studied 77 women who had lost between 11 and 46 pounds and who were then placed on a maintenance program for nine months. The team paid particular attention to defects in two genes previously linked to obesity, the beta-3-adrenergic receptor and uncoupling protein-1.
Over the nine months on maintenance, the women with defects in both of the genes gained an average of 13 pounds, while those with defects in only one or with no defects gained an average of only 0.5 pounds. This combination of defects occurs in only about 10% of the population, the authors cautioned, and thus do not account for all, or even most, cases of obesity.
