High Blood Pressure Treatment Goals

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Treatment Goals for Hypertension

          The ideal blood pressure has eluded medical experts for decades.  For the longest time, a blood pressure of 140/90 or less was thought to be the goal when titrating medications for treatment of hypertension.  Then, in recent years, more aggressive treatment of mild hypertension was advocated, despite the potential risks, including fatigue and muscle weakness and increased risk of serious falls.  Recognizing this, the pendulum swung back again to a less aggressive approach.

          This may change once again as a result of the Systolic Blood Pressure Intervention Trial (SPRINT) sponsored by the National Institutes of Health (NIH) which reported its findings late last year.  In this study, 9,361 adults age 50 and older with systolic blood pressure 130 or higher and cardiovascular risk factors (but not diabetes) were randomly assigned to one of two groups.  One group had a systolic blood pressure target of less than 140 and the other had a systolic blood pressure target of less than 120.  The aggressively treated group faired significantly better.

          As reported in the New England Journal of Medicine, the study was stopped after three years when it became clear that those treated more aggressively had ‘lower rates of fatal and nonfatal major cardiovascular events and death from any cause’ than those treated less aggressively.  So will the pendulum swing back once again to a more aggressive treatment approach for patients with hypertension?  We shall see.    

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Sleep Disordered Breathing

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Sleep Disordered Breathing

          Sleep disordered breathing is a term describing a range of breathing difficulties that can occur during sleep. It can be as simple as common snoring or as severe as sleep apnea. Obstructive sleep apnea occurs when the passage of air is partially or fully blocked due to lack of muscle tone or excess tissue in the upper airway. Central sleep apnea is a central nervous system disorder characterized by reduced ventilatory drive resulting when a patient’s breathing control mechanisms have been affected by a stroke, tumor or other pathological condition. In addition to loud snoring, other symptoms of sleep disordered breathing include episodes of breathing cessation, difficulty staying asleep and excessive daytime drowsiness.

Consequences

          One of the more obvious dangers associated with sleep apnea is that it more than doubles the risk for automobile accidents due to daytime drowsiness. Many patients are not aware that it also has significant consequences for the heart. According to the Wisconsin Sleep Cohort Study in 2015, those with severe untreated sleep disordered breathing are 2.6 times more likely to have coronary heart disease or heart failure than those without it. Obstructive sleep apnea also increases the risk for hypertension and diabetes.

Diagnosis and Treatment

          The diagnosis of sleep disordered breathing is usually made after a sleep study. It is important to determine whether the patient has central sleep apnea or obstructive sleep apnea, because the treatment for each is different. Patients with obstructive sleep apnea are usually treated with CPAP (continuous positive airway pressure) administered by a pump through a mask worn by the patient during sleep. Most individuals notice immediate improvement. They usually experience increased energy and improved alertness during the day and, of course, the benefits for their sleep partner is obvious as well. Weight loss in obese patients with obstructive sleep apnea can also be beneficial. Fortunately, most insurance companies cover the cost of a sleep study and CPAP equipment.

A Special Consideration for Patients with Heart Failure

          Patients with existing heart failure often have central sleep apnea which is an independent marker for poor prognosis in these individuals. While interruptions in ventilation can be harmful to a failing heart, studies have shown that treatment with adaptive servo ventilation (a type of CPAP where pressure is adjusted) in patients with heart failure can sometimes be harmful. If you have any questions about sleep disordered breathing or think you may be experiencing obstructive sleep apnea, in particular, it is important to consult your health care provider. Both the risk of doing nothing and the benefit of treatment can be substantial.

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Haemophilus Influenzae Type B (Hib)

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Another Vaccine Success Story

          Haemophilus Influenzae Type B (Hib) is a bacterium (gram-negative coccobacillus) that can enter the body through the respiratory tract and is a common cause of infections such as otitis media (ear infection). In some cases it can enter the blood stream and travel to other parts of the body where it can cause meningitis and pneumonia. It can also spread locally to the epiglottis where it can cause severe swelling resulting in obstruction of the trachea, the tube through which air passes to the lungs. Obviously, all of these infections caused by Hib can result in serious illness with significant morbidity and mortality. Infants and children under the age of five years are particularly susceptible to infections caused by Haemophilus Influenzae. The Hib vaccine which protects against Haemophilus Influenzae Type B infections has been available since the 1980s and the results have been impressive. The incidence of disease caused by Haemophilus Influenzae has decreased by 99% in children under five years of age in the United States since introduction of the Hib vaccine. This is another stunning public health success story and emphasizes the value of vaccines and the importance of having children vaccinated against these potentially serious infectious diseases.

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A Cup of Coffee

Health Benefits of Drinking Coffee

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Drinking Coffee May Be Beneficial to Your Health

          Could there actually be health benefits to drinking coffee? For years, coffee drinking has gone back and forth from the good list to the bad list, but now it appears that there are more benefits to moderate coffee drinking than harmful effects. In the various scientific studies that have come to this conclusion, moderate coffee drinking is defined as two to five cups per day.

          These studies indicate that coffee consumption may reduce the risk of type 2 diabetes and promote heart health, specifically reducing the risk of heart failure. Several studies have indicated that drinking coffee can reduce the incidence of both liver cancer and cirrhosis of the liver. Finally, coffee consumption seems to be associated with a lower incidence of Parkinson’s disease.

          It’s interesting to note that some of these beneficial effects are seen with decaffeinated coffee, as well. Of course, the benefits you may accrue will depend upon the other ingredients you add to your coffee, like cream and sugar. So, while heavy coffee consumption can increase blood pressure and may have other side effects in some individuals, for most of us, drinking coffee in moderation seems to be beneficial. In fact, it can lower the risk of premature death by up to 15% according to researchers at Harvard’s School of Public Health. So, if you enjoy a few cups of coffee each day as I do, ‘Here’s to your health’!

A Cup of Coffee
My Morning Cup of Coffee

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Kitchen Safety

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Cooking Safely in the Home Kitchen

           One of my favorite memories of the holidays as a child was when my sister and I would make fudge candy and gingerbread cookies with my mother. Getting children involved in cooking at an early age is a wonderful activity that can teach them lifelong skills, inspire a hobby or even lead to a career in the food service industry. And it might even get them away from their electronic devices for a while! Aspiring cooks of all ages should constantly be aware of the health and safety threats lurking in the home kitchen. Since Thanksgiving is the leading day for home cooking fires according to the National Fire Protection Association, this is a good time for all of us to review some basic safety tips.

A Few of My Favorite Kitchen Safety Tips:

-Dress appropriately. Wear shoes and avoid loose fitting, flammable clothing.
-Have a fire extinguisher handy.
-Wipe up spills immediately.
-Turn pot handles away from the front of the stove.
-Learn how to use knives safely.
-Keep hot pads handy and use them.
-Know your limits when lifting.
-Don’t pour water on a grease fire.
-Remember, steam can burn, too.
-Keep pets out of the kitchen and always supervise children in the kitchen.

Check Out this Video on Holiday Kitchen Safety:

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Smoking and Cancer

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Smoking Contributes to Development of Many Types of Cancer

          Smoking has been identified as a causative factor in a number of different types of cancer according to an article published in the June 2015 edition of JAMA Internal Medicine.  The researchers combined data from several studies and concluded that smoking can contribute to the development of twelve types of cancer.  When taken together smoking contributes to nearly half of all deaths due to cancer, according to this study.  Altogether, smoking cigarettes is responsible for more than 345,000 deaths in the United States each year. 

Smoking cigarettes can contribute to the following types of cancer:

Lung Cancer

Cancer of the Larynx

Esophageal Cancer

Mouth and Throat Cancers

Bladder Cancer

Liver Cancer

Cancer of the Uterus and Cervix

Stomach Cancer

Kidney Cancer

Myeloid Leukemia

Pancreatic Cancer

Colorectal Cancer 

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