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by Scott Roberts

FDA Expands Approval for 'Valve in Valve' Aortic Replacement

Now includes people at risk for open-heart surgery complications
TUESDAY, March 31, 2015 (HealthDay News) -- The U.S. Food and Drug Administration said Tuesday that use of the CoreValve "valve-in-valve" aortic replacement has been expanded to include people at extreme risk for serious complications of traditional open-heart surgery.
The CoreValve System is designed for people who had a prior aortic valve replacement and are now in need of a second one, the FDA said in a news release. Some people whose own valves wear out have open-heart surgery to replace the original valve with one made of animal tissue. It's when that second valve needs replacing that the CoreValve product may be prescribed.
The CoreValve valve is made of tissue from the heart of a pig. It's attached to a supportive metal frame of nickel-titanium alloy, the FDA said. Insertion is made via a catheter inserted into a leg artery, or via a small incision between the ribs. This removes the need for traditional open-heart surgery.
The valve was evaluated in a clinical trial involving 143 people. The survival rate of people who received the valve was 95.8 percent after 30 days and 89.3 percent after six months, the agency said.
Major risks of the replacement valve were death, stroke, kidney injury, heart attack, bleeding and the need for a permanent pacemaker. The product should not be used by people with an infection, a mechanical aortic valve, among people who cannot take blood-thinning medication, and among those who have a sensitivity to titanium, nickel or imaging contrast fluid.
The device is produced by Medtronic, based in Minneapolis.
More information
The FDA has more about this approval (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm440535.htm ).
by Scott Roberts

Ob-Gyns: Use Ultrasound to Assess Pelvic Symptoms

It's safer, cheaper than other types of imaging, doctors say
TUESDAY, March 31, 2015 (HealthDay News) -- Ultrasound should be the first type of imaging used to assess pelvic symptoms in women, a group of U.S. experts says.
Ultrasound is safer and more cost-effective than other types of imaging for these types of cases, the team of obstetricians and gynecologists wrote in an article published March 31 in the American Journal of Obstetrics & Gynecology.
They support an American Institute of Ultrasound in Medicine initiative called Ultrasound First, which urges doctors to use ultrasound when evidence shows that it is equally, if not more, effective compared to other imaging methods for the area on the patient's body that requires examination.
"This recommendation applies particularly to obstetric and gynecologic patients. A skillfully performed and well-interpreted ultrasound usually eliminates the need to perform additional more costly and complex cross-sectional imaging techniques," article lead author and institute president Dr. Beryl Benacerraf said in a journal news release.
Currently, many women with pelvic pain, masses or flank pain first undergo CT scans, and sometimes MRIs, noted Benacerraf, who is also a clinical professor in obstetrics, gynecology and reproductive biology and radiology at Harvard Medical School and Brigham and Women's Hospital in Boston.
However, CT scans and MRIs of the pelvis often result in unclear findings that require further clarification using ultrasound, she said.
Moreover, the growing use of CT raises safety concerns, added article co-author Dr. Steven Goldstein, professor of obstetrics and gynecology at NYU School of Medicine.
"The use of CT scans has tripled since 1993," Goldstein said, noting that radiation associated with CT may pose a cancer risk.
It's estimated that 29,000 future cancers could be related to CT done in the United States in 2007 alone, Goldstein added. And nearly half of those predicted cancers were attributed to CT of the pelvis and abdomen, he said.
"For example, patients with suspected kidney stones frequently have a CT scan first, despite the associated radiation burden. In a recent study, most of the patients evaluated first by ultrasound did not ultimately need a CT scan, sparing radiation exposure," Goldstein noted.
Ultrasound imaging uses sounds waves rather than radiation.
More information
The U.S. National Institute of Child Health and Human Development has more about pelvic pain (http://www.nichd.nih.gov/health/topics/pelvicpain/conditioninfo/Pages/default.aspx ).
SOURCE: American Journal of Obstetrics & Gynecology, news release, March 31, 2015
by Scott Roberts

New Stroke Prevention Efforts May Be Paying Off

CDC study finds fewer patients treated in ERs for blood clots in the brain
TUESDAY, March 31, 2015 (HealthDay News) -- Fewer people are being treated in U.S. emergency rooms for strokes caused by blood clots in the brain, which experts read as a sign that current stroke prevention methods are working.
The rate of emergency department visits for either a stroke or a mini-stroke (transient ischemic attack) -- a temporary blockage of blood flow to the brain -- decreased dramatically between 2001 and 2011, according to a new U.S. Centers for Disease Control and Prevention report.
Such ER visits declined 35 percent for adults 18 and older, and 51 percent for those 55 to 74, said the report from the CDC's National Center for Health Statistics (NCHS).
The statistics mirror a "dramatic reduction in stroke fatality in the country, which we believe is likely due to better control of risk factors," said Dr. Larry Goldstein, chief of the division of stroke and vascular neurology and director of the Duke Stroke Center at Duke University Medical Center in Durham, N.C.
People are preventing strokes by taking cholesterol-lowering statin drugs and medications to control high blood pressure, Goldstein said. In addition, fewer people are smoking, which is a leading risk factor for stroke, and indoor air laws are limiting nonsmokers' exposure to secondhand smoke.
The CDC report, published in the March NCHS Data Brief, also contained evidence that doctors are providing more comprehensive care for stroke victims, experts said.
For example, doctors more frequently used MRIs or CT scans to evaluate a patient who came to the emergency room with signs of a blood-clot stroke, the CDC report found.
The percentage of ER stroke visits that involved an MRI or CT scan increased 39 percent between 2001 and 2011, researchers said.
Such scans are important prior to giving patients powerful clot-busting medications that can quickly treat a stroke and prevent further brain damage, said lead report author Anjali Talwalkar, a medical officer with the NCHS.
"If it's a stroke that is a bleed in the brain, you don't want to give certain types of medication," such as clot-busting drugs, since they could cause the bleeding to increase, Talwalkar said. "These scans are definitely a critical piece of care for a stroke."
Experts also found it encouraging that more patients are being admitted into a hospital or transferred to another facility after showing up in an ER for stroke. The number of admissions or transfers increased 10 percent between 2001 and 2011, according to the report.
"That reflects the growing importance of more aggressive stroke treatments," said Dr. Richard Libman, vice chair of neurology for North Shore-LIJ Health System in Manhasset, N.Y.
These aggressive treatments can include what's called "drip and ship," in which patients are given clot-busting drugs at local hospitals and then transferred to stroke centers that can provide more comprehensive care, Libman said.
These stroke centers also have been pioneering ways to clear blood clots by snaking a catheter into a person's head and removing the clot manually, he added.
Not all the news from the CDC report was positive, however.
The researchers also found that fewer people are arriving at the ER by ambulance after suffering stroke symptoms.
The percentage of ambulance-transported stroke patients younger than 75 decreased 41 percent between 2004 and 2011, the report found.
This decrease happened despite public health campaigns aimed at getting people who may be suffering a stroke to call 911 immediately, Libman said.
"Data and studies have shown that if you have a stroke and you get to the hospital early by ambulance, you have a higher chance of being treated with clot-busting drugs than if you arrive by any other mode of transportation," he said.
Clot-busting drugs are only effective when given soon after onset of stroke, and doctors may choose not to use them if hours have passed, Libman said.
"Whenever you have symptoms suggestive of stroke, call 911. Get to the nearest emergency department as soon as possible," he said.
More information
For more on clot-busting drug therapy, visit the U.S. National Library of Medicine (http://www.nlm.nih.gov/medlineplus/ency/article/007089.htm ).
SOURCES: Larry Goldstein, M.D., chief, division of stroke and vascular neurology, and director, Duke Stroke Center, Duke University Medical Center, Durham, N.C.; Anjali Talwalkar, M.D., M.P.H., medical officer, U.S. Centers for Disease Control and Prevention's National Center for Health Statistics; Richard Libman, M.D., vice chair of Neurology, North Shore-LIJ Health System, Manhasset, N.Y.; Trends in Emergency Department Visits for Ischemic Stroke and Transient Ischemic Attack: United States, 2001-2011, National Center for Health Statistics Data Brief, March 31, 2015
by Scott Roberts

Benefits of Iron Supplements Unclear for Pregnant Women, Young Children

Task force concludes there's too little information to recommend screening for deficiencies
TUESDAY, March 31, 2015 (HealthDay News) -- Taking iron supplements during pregnancy doesn't appear to significantly change any health outcomes for mom or baby, a new review shows.
A second review -- this one on infants and toddlers -- found no evidence that iron supplements improved growth or development.
Both conclusions come from a U.S. Preventive Services Task Force (USPSTF) review of the latest research on iron supplementation and screening for pregnant women, babies and young children.
The USPSTF determined that there isn't enough evidence to recommend that pregnant women or infants and children receive iron supplements or be screened for iron deficiencies. But, they also noted there isn't enough evidence to recommend against either practice.
The recommendations regarding prenatal supplements are an unchanged update from those in 2006. What's new is that this study also finds no evidence to support routine screening.
"There is not enough research to demonstrate that women need to be routinely screened for iron-deficiency anemia or that they should routinely take iron supplements in the absence of symptoms," said Dr. Amy Cantor, lead author of the prenatal study.
"It is not particularly harmful to take an iron supplement, but it may not be necessary," added Cantor, who is an assistant professor of obstetrics and gynecology and family medicine at Oregon Health & Science University in Portland.
Generally, a healthy pregnant woman who does not have symptoms of low iron does not need any more than the 27 milligrams per day of iron that the Institute of Medicine recommends, Cantor said.
Her team analyzed the evidence from 11 trials on pregnant women routinely taking iron supplements. It found that supplements didn't affect women's quality of life or rates of C-sections, underweight newborns, preterm birth or infant death.
The researchers did find that women's iron levels improved with supplements. But, whether or not there is a benefit from this change is unclear, according to the investigators.
The researchers didn't find any studies looking at the benefits of screening for iron deficiency.
Not everyone was on board with the USPSTF recommendations.
Iron helps blood carry oxygen and nutrients throughout the body, so low iron levels can cause problems during pregnancy, said Dr. Andre Hall, an obstetrician and gynecologist at Birth and Women's Care in Fayetteville, N.C.
"In addition, if a mother is anemic, she has less reserve in cases of bleeding during delivery," he said.
According to Dr. Jill Rabin, co-chief of the division of ambulatory care at Women's Health Programs-PCAP Services in the North Shore-LIJ Health System of New Hyde Park, N.Y., doctors may still recommend that women take iron supplements and continue to screen for iron deficiency at the beginning of prenatal care and late in the third trimester.
"We still continue to recommend supplements and screening because we know iron helps carry the blood to the mom and the baby," said Rabin. "There are no major harms, and the benefits may be enormous, so we should just keep doing what we're doing and keep doing more research," she said.
The most common problems associated with taking iron supplements were nausea, constipation and diarrhea that went away on their own, study author Cantor said. Women can get iron through a diet rich in dark green leafy vegetables, various meats and seafood, beans, dried fruit and iron-fortified cereals, breads and pasta, she said.
The findings in infants and toddlers were similar to those for pregnant women, according to Marian McDonagh, a professor of epidemiology at Oregon Health & Science University in Portland, and lead author of that study.
McDonagh's team reviewed 10 trials they identified that measured effects of iron supplements in children aged 6 months to 2 years.
"Although some evidence on routine iron supplementation in children ages 6 to 24 months indicates improvements in hematologic [blood] values, limited evidence from controlled studies indicates no benefits in growth or neurodevelopmental test scores, and no other clinical outcomes have been evaluated in the literature for children living in developed countries," McDonagh said. "The effects of routine iron supplementation in young children are unknown at this time."
As in the maternal studies, the researchers weren't able to find any studies that measured the benefits or harms of screening children for iron deficiency.
The American Academy of Pediatrics recommends screening children before age 2, and this review doesn't have enough evidence to sway recommendations that are in place, according to Dr. Roya Samuels, a pediatrician at Cohen Children's Medical Center in New Hyde Park, N.Y.
"Despite the conclusions, it's still important to do routine iron screenings, especially in infants and toddlers because that age range involves rapid growth, and there's a higher likelihood that there could be problems with eating," Samuels said. "Toddlers who only want to eat bread and pasta may not be getting enough iron."
The findings on pregnant women were released online March 30 in the Annals of Internal Medicine. The findings on children were published in the April issue of Pediatrics.
More information
Learn more about preventing anemia from the U.S. National Heart, Lung, and Blood Institute (http://www.nhlbi.nih.gov/health/health-topics/topics/ida/prevention ).
SOURCES: Amy G. Cantor, M.D., assistant professor, departments of obstetrics and gynecology and family medicine, Center for Women's Health, Oregon Health & Science University, Portland, Ore.; Jill Rabin, M.D., co-chief, division of ambulatory care, Women's Health Programs-PCAP Services, North Shore-LIJ Health System, New Hyde Park, N.Y.; Andre F. Hall, M.D., Birth and Women's Care, Fayetteville, N.C.; Marian S. McDonagh, PharmD, department of medical informatics and clinical epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Ore.; Roya Samuels, M.D., pediatrician, Cohen Children's Medical Center, New Hyde Park, N.Y.; April 2015, Pediatrics; March 30, 2015, Annals of Internal Medicine, online
by Scott Roberts

Clues to 'Brain Fog' in Chronic Fatigue Patients Found in Spinal Fluid

Study reveals evidence that it's 'not made up,' researcher says
TUESDAY, March 31, 2015 (HealthDay News) -- People with chronic fatigue syndrome show a distinct pattern of immune system proteins in their spinal fluid -- a finding that could shed light on the "brain fog" that marks the condition, researchers say.
The new study found that, compared with healthy people, those with chronic fatigue syndrome had lower levels of certain immune-system proteins called cytokines in the fluid that bathes the spinal cord and brain.
The exception was one particular cytokine, which was elevated in not only people with chronic fatigue, but also those with multiple sclerosis.
The finding could offer clues as to why people with chronic fatigue syndrome typically have problems with memory, concentration and thinking, said lead researcher Dr. Mady Hornig, a professor at Columbia University's Mailman School of Public Health in New York City.
The study also bolsters evidence that some type of immune dysfunction underlies the puzzling disorder, Hornig said.
Chronic fatigue syndrome is known medically as myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS. In the United States, it affects up to 2.5 million people, according to the Institute of Medicine, a scientific panel that advises the federal government.
In February, the IOM released a report affirming that chronic fatigue syndrome is a legitimate medical condition that many health professionals still misunderstand -- or even dismiss as a figment of patients' imagination.
The term "chronic fatigue syndrome" was coined back in 1988, and in hindsight, it was a "lousy" choice, said Suzanne Vernon, a virologist and scientific director of the Solve ME/CFS Initiative, based in Los Angeles.
"People hear it and think, 'Oh, you're tired. I'm tired, too,'" said Vernon, who was not involved in the study. "But this is debilitating fatigue. It's like having a case of the flu that never goes away."
Plus, symptoms go beyond fatigue, and include what's been dubbed "brain fog" -- a collection of thinking-related problems such as confusion and difficulty with concentration and short-term memory.
For the new study, reported March 31 in the journal Molecular Psychiatry, Hornig's team studied spinal-fluid samples from 32 people with chronic fatigue syndrome, 40 with multiple sclerosis, and 19 healthy people.
Overall, the researchers found reduced levels of most cytokines in chronic fatigue syndrome patients' spinal fluid, versus the two other groups. But one cytokine, eotaxin, was elevated in people with chronic fatigue syndrome and those with multiple sclerosis.
The significance of that finding is not clear yet, Hornig said. But she said eotaxin is involved in allergy-like immune responses.
To Vernon, the findings offer "additional evidence of clear [biological] markers in ME/CFS."
"These biomarkers are indications of some kind of disease process," Vernon said. In other words, she added, chronic fatigue syndrome is "not made up."
Why did the study include people with multiple sclerosis? There are some similarities between MS and chronic fatigue syndrome, Hornig explained. MS patients suffer fatigue, and the disease is believed to be caused by an abnormal immune reaction -- in this case, against the body's own nerve tissue.
The precise cause of chronic fatigue syndrome is far from clear, but in general, it's thought to involve some type of immune system dysfunction, Hornig explained.
In a recent study, her team found that in people who've had chronic fatigue syndrome for a relatively short time -- fewer than three years -- cytokine levels in the blood were actually elevated. They dropped again, though, in people who'd had the disease for a longer time.
People in the current study had had chronic fatigue syndrome for about seven years. So the relatively low cytokine levels in their spinal fluid "parallel" what was seen in the earlier study, Hornig said.
"I think what we're seeing is an immune system exhaustion over time," Hornig speculated.
The theory is that the immune system may initially go into overdrive against an invader -- like a virus -- and then be unable to dial itself down, Hornig explained. That could account for the high cytokine levels in people who've had chronic fatigue syndrome for a short time.
Over time, though, the immune system may essentially wear itself down, leading to weak responses to mild infections that a healthy immune system would readily handle, Hornig suggested.
One hope, Hornig said, is that these findings could lead to objective tests that can diagnose chronic fatigue syndrome early.
An objective test, such as a blood test measuring cytokines, would be welcome, Vernon said. Right now, she noted, people often wait for years for a diagnosis, which is based on symptoms.
Understanding the biology of the disease could also lead to treatments, Hornig said.
"We can't promise this will translate into treatments around the corner," she said. "But we hope to start giving doctors some tools."
More information
The U.S. Centers for Disease Control and Prevention has more on chronic fatigue syndrome (http://www.cdc.gov/cfs/ ).
SOURCES: Mady Hornig, M.D., professor, epidemiology, Columbia University Mailman School of Public Health, New York City; Suzanne Vernon, Ph.D., scientific director, Solve ME/CFS Initiative, Los Angeles, Calif.; March 31, 2015, Molecular Psychiatry, online
by Scott Roberts

Eat Right to Protect Your Sight

Oily fish, broccoli and berries may benefit your eyes, expert says
TUESDAY, March 31, 2015 (HealthDay News) -- A number of nutrients can help keep your eyes healthy, and some may even improve your eyesight, an eye doctor says.
It's particularly important to eat a variety of fresh fruits and vegetables, said Dr. James McDonnell, a pediatric ophthalmologist at Loyola University Health System in Maywood, Ill.
"Make a colorful plate, especially with greens, blues and reds. Certain foods have distinct benefits for the eyes in addition to overall health, including many of the trendy superfoods such as kale, broccoli and sweet potatoes," he said in a Loyola news release.
McDonnell said healthy eating might help protect you from cataracts, macular degeneration -- a leading cause of vision loss in older Americans -- and even blindness.
He listed several nutrients that are especially good for your eyes.
Astaxanthin. "This supernutrient protects eyes from developing cataracts, macular degeneration and blindness," McDonnell said. "Seaweed and wild, rather than farmed, salmon are excellent choices high in astaxanthin. It also aids in so many aspects of wellness that astaxanthin is my top recommendation for incorporation into your diet."
Omega-3. This fatty acid contained in fish protects against dry eye and age-related macular degeneration, he said.
"Studies show that individuals who ate oily fish such as tuna, sardines, herring and salmon at least once a week were 50 percent less likely to develop neovascular [wet] macular degeneration than those who ate fish less than once per week," McDonnell said.
Anthocyanins. "Blueberries, bilberries and especially black currants contain high amounts of anthocyanins and help to maintain the health of the cornea and blood vessels in every part of the eye," McDonnell said. "They also help reduce the risk of cataracts and macular degeneration as well as decrease inflammatory eye disease and diabetic retinopathy."
Vitamin D. "Safe sun exposure, fish oils, fatty fish and, to a lesser extent, beef liver, cheese, egg yolks and certain mushrooms contain this master hormone, which acts on more than 4,000 genes," McDonnell said. He added that vitamin D3 supplementation has been shown to help prevent age-related macular degeneration, reduce retinal inflammation and improve vision.
Zeaxanthin. This nutrient, which McConnell said reduces the risk of age-related macular degeneration, is found in dark green vegetables such as kale, broccoli, collards, raw spinach and romaine lettuce. "Lightly cooking these vegetables increases your body's ability to absorb these nutrients," McDonnell said.
Bioflavonoids. Found in tea, red wine, citrus fruits and cherries, bioflavonoids may lower the risk of cataracts and macular degeneration, he said. And beta-carotene, contained in carrots, sweet potatoes, spinach, kale and butternut squash, protects you against night blindness and dry eyes, the eye doctor noted.
Lutein. This nutrient is also good for your eyes. "The best source is from organic eggs laid by pastured organic hens. You can also take supplements made from marigold flowers," McDonnell said.
More information
The U.S. National Eye Institute has more about healthy eyes (https://www.nei.nih.gov/healthyeyes/ ).
SOURCE: Loyola University Health System, news release, March 30, 2015
by Scott Roberts

Health Highlights: March 31, 2015

Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:
Ancient Eye Remedy Kills Superbug: Study
A 1,000-year-old treatment for eye infections may offer a way to treat a superbug called methicillin-resistant Staphylococcus aureus (MRSA), according to British researchers.
The recipe for the ancient Anglo-Saxon treatment calls for garlic and onion or leek, wine, and bile from a cow's stomach. The ingredients are brewed in a brass vessel, USA Today reported.
The concoction -- called Bald's eye salve -- killed up to 90 percent of MRSA bacteria in the skin wounds of mice, according to the study to be presented Wednesday at at Society for General Microbiology meeting in Birmingham, England.
"We let our artificial 'infections' grow into dense, mature populations called 'biofilms', where the individual cells bunch together and make a sticky coating that makes it hard for antibiotics to reach them," Freya Harrison, a microbiologist at the University of Nottingham, said in a news release, USA Today reported.
"But unlike many modern antibiotics, Bald's eye salve has the power to breach these defenses," she noted.
The team is seeking further funding to continue their research, USA Today reported.
Idaho Wins Medicaid Pay Fight in Supreme Court Case
Health care companies cannot sue to force states to increase their Medicaid reimbursement rates to keep pace with rising medical costs, the U.S. Supreme Court ruled Tuesday.
In the 5-4 decision Tuesday, the justices said medical companies do not have a private right to enforce federal Medicaid funding laws against states if Congress has not created such a right, the Associated Press reported.
The decision came in a lawsuit launched against Idaho in 2009 that claimed the state was unfairly keeping Medicaid reimbursement rates at 2006 levels. Lower courts ruled against Idaho and the increased reimbursements cost the state an extra $12 million in 2013.
In siding with the state, the Supreme Court said only federal agencies that oversee Medicaid can decide if a state is complying with reimbursement rules, the AP reported.
Younger People, Women Most Likely to Use Cellphone While Driving: Study
Women and young people are most likely to talk on a cellphone while driving, a new study finds.
Researchers looked at 1,280 drivers in Texas and found that those younger than 25 were more than four times as likely as older drivers to use a cellphone while behind the wheel, and that women were 63 percent more likely to do so than men, The New York Times reported.
The study in the journal Preventive Medicine Reports also found that lone drivers were more than four times as likely to use a cellphone while driving than drivers with passengers, and that women were more than twice as likely to text while behind the wheel than men.
The study was conducted between 2011 and 2013. During that time, the percentage of drivers using cellphones fell from 20.5 percent to 16.4 percent, but texting while driving increased from 6.4 percent to 8.4 percent, The Times reported.
There are no statewide laws in Texas that ban cellphone use while driving.
Pharmacists Shouldn't Provide Drugs For Executions: Association
A leading U.S. pharmacists group says its members should not provide drugs for use in lethal injections because doing so is contrary to pharmacists' role as health care providers.
The policy was adopted Monday by the American Pharmacists Association at its annual meeting. While the association does not have the legal power to prevent its more than 62,000 members from providing drugs for executions, its policies set ethical standards, the Associated Press reported.
A number of doctors groups have similar policies.
The pharmacists association's new policy places another roadblock in the way of states that want to use lethal injections to execute prisoners. Some are turning to alternative methods, such as the electric chair or firing squad, the AP reported.
by Scott Roberts

Heart Groups Issue Updated Blood Pressure Guidelines

Aim is more flexibility for those with heart disease, doctors say
TUESDAY, March 31, 2015 (HealthDay News) -- Three leading groups of heart experts have issued updated guidelines that set blood pressure goals for people with heart disease.
Specifically, the guidelines reinforce a target blood pressure of less than 140/90 mm Hg for those at risk for heart attack and stroke. The guidelines also set a goal of 130/80 mm Hg for those with heart disease who have already had a heart attack, stroke or a ministroke, or who have had a narrowing of their leg arteries or an abdominal aortic aneurysm.
However, the new guidelines are intended to be more flexible than ones crafted in 2007, said Dr. Clive Rosendorff, chairman of the committee that wrote the updated guidelines. Ultimately, the blood pressure goal any individual patient tries to achieve should be left to the discretion of the doctor and the patient.
For example, the lower goal may not be appropriate for older, frail patients who might experience dizziness if their blood pressure drops too much.
"Guidelines are simply that, guidelines, they are not inflexible rules," Rosendorff said.
The updated guidelines, from the American Heart Association, the American College of Cardiology and the American Society of Hypertension, were published March 31 in the journal Hypertension.
"In patients with heart disease, untreated high blood pressure is a major risk for heart attack and stroke," said Rosendorff, who is also a professor of medicine at the Icahn School of Medicine at Mount Sinai Medical Center in New York City.
Rosendorff said these guidelines are for patients with heart disease. New blood pressure guidelines for people who have high blood pressure but do not have heart disease are in the works, but those won't be released for some time, he said.
High blood pressure has become a growing problem in the United States during the past decade, according to a recent report from the U.S. Centers for Disease Control and Prevention. The overall death rate from high blood pressure has increased 23 percent since 2000, even as the death rate from all other causes has dropped 21 percent. That spike was seen in both genders and was most marked among those aged 45 to 64 and those over 85.
According to Rosendorff, one change in the updated guidelines is a concise statement about which drugs should be used to lower blood pressure in patients with heart disease.
"There are three drugs which have been shown to improve outcomes," he said. These include beta-blockers that slow the heart rate and reduce the force of cardiac contraction and also increase blood flow to the heart, Rosendorff said.
The guidelines also recommend angiotensin II receptor blockers (ARBs) and angiotensin-converting-enzyme inhibitors (ACE inhibitors), which increase the size of blood vessels, thus lowering blood pressure, and diuretics that lower blood pressure by reducing the amount of fluid in the body.
Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said men and women with high blood pressure and heart disease may benefit from more cohesive management strategies that target both conditions.
"As large numbers of men and women have not achieved optimal control of their blood pressure and are having major cardiovascular events which could have been prevented, more needs to be done to ensure implementation of these recommendations into routine clinical practice," Fonarow said.
Dr. Harlan Krumholz, a professor of cardiology at the Yale School of Medicine, views the updated guidelines as part of an ongoing debate among experts as to what blood pressure goals should be.
"The main issue is that not many contemporary trials have focused on patients with high blood pressure in this range, and there is some uncertainty about who benefits most from drug treatment, whether adding additional pills is helpful, and in what sequence. As always, the best path for people with minor elevations of blood pressure is to treat it with lifestyle change, including diet and exercise," he said.
More information
Visit the American Heart Association (http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/About-High-Blood-Pressure_UCM_002050_Article.jsp ) for more on high blood pressure.
SOURCES: Clive Rosendorff, M.D., Ph.D., chairman, writing committee, and professor of medicine, Icahn School of Medicine at Mount Sinai Medical Center, New York City; Gregg Fonarow, M.D., professor, cardiology, University of California, Los Angeles; Harlan Krumholz, M.D., professor, cardiology, Yale Medical School, New Haven, Conn.; March 31, 2015, Hypertension
by Scott Roberts

Letting Kids Sip Alcohol May 'Send Wrong Message'

Study suggests it might make booze more appealing to children
TUESDAY, March 31, 2015 (HealthDay News) -- Children who are allowed occasional sips of alcohol are more likely to start drinking by the time they're in high school, a new study suggests.
Researchers followed 561 middle school students in Rhode Island for about three years. At the start of sixth grade (about age 11), nearly 30 percent of the students said they'd had at least one sip of alcohol.
In most cases, those sips were provided by parents, often at parties or special occasions.
By ninth grade, 26 percent of those who'd had sips of alcohol at a younger age said they'd had at least one full alcoholic drink, compared with less than 6 percent of those who didn't get sips of alcohol when younger.
The researchers also found that 9 percent of the sippers had gotten drunk or engaged in binge drinking by ninth grade, compared with just under 2 percent of the non-sippers.
The study was published March 31 in the Journal of Studies on Alcohol and Drugs.
The findings don't prove that sips of alcohol at an early age are to blame for teen drinking, said lead researcher Kristina Jackson, of Brown University's Center for Alcohol and Addiction Studies, in Providence, R.I.
"We're not trying to say whether it's 'OK' or 'not OK' for parents to allow this," Jackson said in a journal news release.
She noted that some parents believe that introducing children to alcohol at home teaches them about responsible drinking and reduces the appeal of alcohol.
"Our study provides evidence to the contrary," Jackson said.
Giving sips of alcohol to young children may send them a "mixed message," she suggested.
"At that age, some kids may have difficulty understanding the difference between a sip of wine and having a full beer," Jackson said.
More information
The U.S. Substance Abuse and Mental Health Services Administration discusses how to prevent your child from drinking (http://www.samhsa.gov/underage-drinking/parent-resources/what-you-can-do-prevent-your-child-drinking ).
SOURCE: Journal of Studies on Alcohol and Drugs, news release, March 31, 2015
by Scott Roberts

Young People At Risk of Second Injury After Knee Surgery

Study finds repeat problems common after early ACL repair
SATURDAY, March 28, 2015 (HealthDay News) -- One-third of young athletes who have surgery to repair the anterior cruciate ligament (ACL) in the knee suffer another ACL injury later in life, new research finds.
"Our study shows that young knees are more prone to re-injury than the adult population when compared to other research in this area, and is the first study to examine the incidence and risk factors for further ACL injury in a solely juvenile population over the long term," study author Dr. Justin Roe, of the North Sydney Orthopaedic and Sports Medicine Centre in Australia, said in a society news release.
"While surgery still may be the best option for many ACL injuries, it brings to light the important factors physicians must consider when treating the younger population," he added.
The Australian researchers looked at nearly 250 athletes who had ACL reconstruction surgery between 1993 and 1998. They were all 18 and younger when they had surgery. Rugby or soccer was the sport of choice for about half of the athletes.
More than two-thirds of the athletes returned to their normal level of sports activity after surgery.
In the 15 years after ACL surgery, 75 (31 percent) of the athletes had another ACL injury, according to the study.
The findings were to be presented Saturday at an American Orthopaedic Society for Sports Medicine meeting in Las Vegas. Findings presented at meetings are generally viewed as preliminary until they've been published in a peer-reviewed journal.
More information
The U.S. National Library of Medicine has more about ACL injury (http://www.nlm.nih.gov/medlineplus/ency/article/001074.htm ).
SOURCE: American Orthopaedic Society for Sports Medicine, news release, March 28, 2015

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