Newsletter 06/29/18 – A compilation of Noteworthy Items

To my Patients and Friends,

Here are this week’s medical news updates.  Hopefully there’s a little something for everybody… enjoy!

New blood pressure guidelines

It’s easy to get confused about the new blood pressure guidelines from the American Heart Association.  Formerly, hypertension (high blood pressure) was defined as a reading at or above 140 mm Hg systolic (“top” number) or 90 mm Hg diastolic (“bottom” number).  More recently, hypertension has been redefined as a reading at or above 130/80.  This change was implemented because research has shown that complications (such as heart attack or stroke) can arise with increased frequency even when readings are below 140/90.

According to the current guidelines, systolic blood pressure between 120 and 129 mm Hg (assuming the diastolic reading remains below 80 mm Hg) is considered “elevated” (but does not qualify as hypertension); for all who fall into this category, lifestyle modification measures are recommended to lower BP, as follows:

  • Weight loss (blood pressure can drop by 1 mm Hg for every couple of pounds lost)
  • A healthy diet rich in fruits, vegetables and whole grains and low in salt and saturated fat
  • Exercise, including both aerobic activity as well as resistance training (90-150 minutes per week)
  • Moderate alcohol intake (no more than one drink per day for women or two drinks per day for men)

Stage I hypertension is defined as a systolic blood pressure of 130-139 mm Hg and/or a diastolic blood pressure of 80-89 mm Hg).  The above lifestyle measures are recommended for these patients.  In addition, for those with coronary artery disease or increased cardiovascular risk (as calculated according to specific guidelines), stage I hypertension is treated with both lifestyle modification and blood pressure medication.  For stage II hypertension (140/90 or higher), medication is recommended across the board (along with the above lifestyle measures).  Blood pressure at or above 180/120 (deemed a hypertensive crisis) requires urgent evaluation.

Home blood pressure monitoring using an automated cuff can be very useful, as readings can be falsely elevated in medical settings (a phenomenon often referred to as “white coat syndrome”).  It’s important to use proper measurement technique, and blood pressure determination should be based on an average of 2 to 3 readings taken on a couple of different occasions.  Remember to avoid checking blood pressure wrhen you have a full bladder, while sitting cross-legged, while talking, or immediately after physical activity.  Be sure the blood pressure cuff is not too small or placed over clothing, and remember that the measured arm should be supported at the level of the heart.

For all patients taking blood pressure medication, the goal is to keep blood pressure below 130/80.  And remember: normal is less than 120/80.

Still confused?  Talk to your doctor… and remember that healthy lifestyle habits can go along way to maintaining healthy blood pressure!

Antidepressants: weighing the pros and cons

We’ve known for some time that short-term use of antidepressant medications can contribute to weight gain.  However, we’ve had limited information regarding the potential long-term effects.  A recent study published in the British medical Journal (BMJ) provides some clarity by showing that long-term weight gain can indeed be associated with these medications.  The precise mechanism remains unknown, but because of the frequency with which antidepressants are prescribed, this phenomenon represents a potential public health concern.  If you happen to be on an antidepressant medication, be sure to maintain good lifestyle habits in order to minimize weight gain (and the associated impacts on overall health).

and before starting an antidepressant, check your medicine cabinet

A study recently published the Journal of the American Medical Association (JAMA) has found that approximately one third of U.S. adults take prescription medications that can cause depression as a side effect.  The list of potential culprits includes over 200 commonly used medications in many different categories.  Be sure to discuss these potential side effects with your physician, especially if you are experiencing any feelings of depression, such as sadness, low energy, lack of enthusiasm, decreased appetite, sleep difficulties, problems focusing, unexplained aches or pains, or thoughts of harming yourself.

and focus on fitness as another means of avoiding depression

A study recently published in JAMA Psychiatry has found that cardiorespiratory fitness in middle age is linked to a reduced risk of depression, heart attack or stroke in later years.  So if you find yourself spending a little bit too much time on the couch, make a commitment to become more active this summer… as it can pay off in the long run.

Marriage is good for the heart… literally

A recent research review published in the journal Heart has demonstrated that never married, widowed or divorced individuals may be at greater risk for developing cardiovascular disease (including heart attack and stroke) than married individuals.  Marriage certainly isn’t the largest predictor of cardiovascular disease (other factors such as age, high blood pressure, high cholesterol, smoking and diabetes are more significant), and it’s hard to nail down exactly why this phenomenon has been observed.  One of the authors speculates that “a wide range of behavioral factors, psychosocial processes, and personal and cultural factors” could all contribute to an individual’s cardiovascular risk profile.  My inclusion of this article isn’t meant to be a plug for marriage per se, but it does seem to me that these findings add to the growing body of evidence suggesting that having meaningful relationships can be important for good health.

The eyes are the windows to… well, everything

Many systemic diseases, including diabetes, vascular disease and hypertension often exhibit signs that can be picked up by an astute ophthalmologist during a routine eye exam.  Now we have evidence that early cognitive decline may also be associated with specific ocular findings.  A pair of studies recently published in JAMA Neurology have shown that a specific finding during an eye exam (namely, thinning of the retinal nerve fiber layer- or RNFL) is tied to worse cognitive function and increased risk for future cognitive decline and dementia (including Alzheimer’s dementia).  Optical Coherence Tomography (or OCT)– the technique used to take these measurements- is readily available in many eye clinics.  Although this finding is not specific for dementia and can be associated with other conditions such as glaucoma, it may be worth asking your ophthalmologist about including this simple test as part of a routine eye exam, especially if you have concerns about cognitive decline or if you have a family history of dementia and wish to gain a better understanding of your potential risk.

Another study recently published in JAMA Ophthalmology draws a connection between worsening vision and cognitive decline.  It is uncertain whether the two phenomena occur simultaneously because of overlapping neural pathways, or because worsening vision leads to decreased brain stimulation which can then in turn allow for decline in cognitive function.  Regardless, this presents one more reason to check in with your ophthalmologist on a regular basis.

Preterm babies can experience attention difficulties

We have known for some time that early premature birth can increase the risk of Attention Deficit/Hyperactivity Disorder (ADHD) in these children, but a new study from Norway recently published in JAMA Pediatrics has shown that premature infants born at a gestational age as late as 34 weeks are at increased risk of exhibiting signs of ADHD by age 5.  This was found to be especially true for girls (for reasons which are unclear).  It’s an interesting observation… and it certainly represents an opportunity for some new parents to proactively ensure their kids’ healthy development by looking out for emerging signs or symptoms of ADHD.

Is that penicillin allergy for real?

Patients with a penicillin allergy documented in their medical records are at increased risk for significant, potentially life-threatening infections, according to a study recently published in the British Medical Journal.  Studies have shown that the vast majority of people who have a documented penicillin allergy are in fact not allergic to penicillin.  In many cases, the allergy is documented as a precaution due to a family history of penicillin allergy, or perhaps due to a suspected sensitivity that has long-since been outgrown.  In any case, when patients are labeled as penicillin-allergic, physicians are obliged to treat infections using other categories of antibiotics which can often pose greater risks for toxicities and side effects.  Importantly, these broad spectrum antibiotics can also predispose patients to secondary infections such as methicillin-resistant Staphylococcus aureus (or MRSA– a multi drug-resistant bacteria that can cause severe infections) and Clostridium difficile (or C. diff– which causes a severe form of colitis).  So if there is any question as to whether or not you have a true penicillin allergy, it would be well worth your time to review your history carefully and perhaps consult with an allergist in order to be definitively tested.

That’s all for now… stay cool this weekend, and happy 4th!