Marion County Medical Center

Health Shorts

Decmber 2005

Ambulatory BP Monitoring:
Good but Not Always Necessary
Most medical experts agree that 24-hour ambulatory blood pressure monitoring is the most effective way to measure blood pressure and diagnose hypertension. The patient wears the device all day and during sleep to measure how his or her blood pressure responds to various situations. Over a six-month period, according to one study, ambulatory monitoring led to less intensive medication therapy and better control of blood pressure.

Ambulatory monitoring is relatively expensive, however, and the THOP study (Treatment of Hypertension Based on Home or Office Blood Pressure) found that home monitoring also resulted in less intensive drug therapy and lower medical costs. Home monitoring is endorsed as a better alternative to ambulatory monitoring by the U.S. Joint National Committee and the European Society of Hypertension.
[SOURCE: Louis Kuritzky, “Self-Measured Home Blood Pressure in Predicting Ambulatory Hypertension,” Clinical Cardiology Alert, February, 2005; Caroline Wellbery, “Blood Pressure Monitoring: Home vs. Physician’s Office,” American Family Physician, October 1, 2004; George Stergiou, et al, “Self-Monitoring of Blood Pressure at Home Is an Important Adjunct to Clinic Measurements,” British Medical Journal, October 16, 2004]

BP Control Essential for Diabetics
From 55 to 65 percent of Americans with diabetes also have high blood pressure, and it increases their risk for cardiovascular disease. According to the HOT (Hypertension Optimal Treatment) study, subjects following intensive control of blood pressure had 51 percent fewer heart attacks, strokes and other cardiac-related events.

The American Diabetes Association recommends a blood pressure goal of 130/80 or lower for diabetics.
[SOURCE: John R. White, Jr. and Jason Schick, “Home Blood Pressure Monitoring and Diabetes,” Clinical Diabetes, Winter, 2004]

Buying a Home BP Monitor
When you’re buying a home blood pressure monitor, look for the seal of the Association for the Advancement of Medical Instrumentation (AAMI), the group responsible for testing and setting standards.

There are many high-quality monitors on the market, ranging in price from $10 to $125, depending on features they offer. Manufacturers include Omron, A&D Medical LifeSource, Lumiscope, Mark of Fitness, Panasonic and Samsung. After testing 16 of the best-selling monitors, Consumer Reports selected the Omron Intellisense HEM-711AC as its number one choice. A Wall Street Journal article gave top honors to A&D Medical LifeSource monitor #UA-787.
[SOURCE: John R. White, Jr. and Jason Schick, “Home Blood Pressure Monitoring and Diabetes,” Clinical Diabetes, Winter, 2004]

White Coat Effect and Its Reverse Side
In what is known as the “white coat effect,” some individuals have higher blood pressure when it is recorded by a doctor or nurse. To account for this effect in determining treatment, patients are often asked to carry an ambulatory monitor for 24 hours or to make numerous recordings on a home monitor. The idea is to record blood pressure throughout the day with various activities.

On the other hand, one study found significantly higher readings at home than in a doctor’s office–presumably because of faulty technique or anxiety about the act of measuring blood pressure.
[SOURCE: Anne D. Walling, “Accuracy of Blood Pressure Self-Monitoring,” American Family Physician, November 1, 2003]

Reinforcing Bad Antibiotic Behavior
Have you ever gone to the doctor for antibiotics to treat frustrating cold symptoms? If the symptoms disappeared within a few days, you may have become a “repeat offender”–going in for antibiotics even more quickly the next time a cold bothered you.
In fact, antibiotics can do nothing to counter a cold or any other viral infection. And a cold will clear up within a few days whether you do anything or not.

Doctors often feel pressured to prescribe antibiotics, often on the slight chance that the cold has triggered a more serious bacterial infection. But taking antibiotics when you don’t need them can increase the number of antibiotic-resistant bacteria in your body and put you at risk of a serious illness at some time in the future.
[SOURCE: Caroline Wellbery, “Antibiotic Prescribing for Upper Respiratory Infections,” American Family Physician, May 15, 2004]

Kids More Prone to Ear Infections
For pre-school children, ear infections are more common than any other illness except the common cold. By age five or six, ear infections have become much less common.

Young children are more vulnerable because: •Their eustachian tubes, which connect the nasal passages with the middle ears, are shorter, more horizontal, narrower and less stiff than those of adults.
•The adenoids, located in the back of the throat near the eustachian tubes are large in children and often block the opening.
• A child’s immune system is not fully developed until about age seven. As a result, young children are more vulnerable to infections.
•Children who attend large day care centers or pre-schools have greater exposure to disease-causing organisms, particularly during the winter months.
[SOURCE: “Middle Ear Infections,” Nemours Foundation, KidsHealth, updated and reviewed by Barbara P. Homeier, M.D., January, 2005]

Back Sleepers Have Fewer Infections
To reduce the risk of Sudden Infant Death Syndrome (SIDS) doctors have for several years advised parents to put their babies to sleep on their backs. A National Institute of Health study recently found that back sleeping babies also have fewer doctor visits for ear infections and a reduced incidence of fever, stuffy nose and upper respiratory infection.

[SOURCE: “Help Your Baby Fight Ear Infections,” Vibrant Life, July-August, 2005]

Wait and See Approach Works
Two thirds of children treated for middle ear infections with a “wait and see” approach plus pain medication got better without eventually needing antibiotics, according to a recent study.

Children who received antibiotics immediately had faster relief of symptoms and required fewer pain medications but also developed more antibiotic-resistant bacterial strains in their nasal passages, putting them at future risk. Parents of the subjects in both groups were equally satisfied, given that they were educated about the reason for the wait and see approach.
[SOURCE: David P. McCormick, M.D., et al, Pediatrics, June, 2005]

Isolation No Cure for the Flu
The flu is transmitted by social contact but the best protection is not isolating yourself but getting a flu shot.

In a study of 83 students just given flu shots, subjects who considered themselves “lonely” produced fewer antibodies than those who ranked themselves “socially connected.” Carnegie Mellon researchers theorized that loneliness and isolation produced stress that had a negative effect on the immune system.
[SOURCE: “Safety in Numbers,” Men’s Health, July-August, 2005]

Pre-Schoolers Key to Spread of Flu
Pre-school children, aged three to four, were first to be infected and treated for influenza each year according to data collected from emergency departments in Massachusetts from 2000 to 2004.

“These and other data suggest that targeting yearly influenza vaccination to younger children may benefit the entire community,” the authors wrote.
[SOURCE: Miriam E. Tucker, “Pre-School Children Are First To Get Flu,” Pediatric News, November, 2005]

Thick Phlegm? Drink More Water
When you suffer from thick phlegm, chest congestion and heavy coughing, you can get some relief with several over-the-counter remedies such as Mucinex DM, Robitussin and Tobitussin DM. One simple way to break up the phlegm and make expectorants more effective is to drink more water.
[SOURCE: “From the Pharmacy,” Saturday Evening Post, November-December, 2005]

Avoid These Supplements Before Surgery
Some dietary supplements can increase the risk of complications during surgery. Surgical patients should report to their doctor all supplements they are taking and discuss which ones should be discontinued and when.

Garlic, gingko, ginseng and St. John’s wort, for example, increase the risk of bleeding and should be discontinued at least a week before surgery. Prolonged use of echinacea can suppress immunity and result in poor wound healing. Kava and valerian intensify the sedative effect of anesthesia. Ma huang creates an elevated risk of heart attack.
[SOURCE: Catherine Golub, “Ready Yourself for Recovery: Tips for Pre- and Post-Op Nutrition,” Environmental Nutrition, November, 2001.

Compression Key To Successful CPR
“Push hard, push fast,” is the key advice in the new American Heart Association guidelines for delivering CPR (cardiopulmonary resuscitation) to a person having cardiac arrest.

Compression on the patient’s chest is more important than mouth-to-mouth resuscitation, according to the AHA. Guidelines call for 30 chest compressions (instead of 15 as previously recommended) for every two rescue breaths. There’s no need to stop and check to see how the patient is responding; just keep on pushing. According to research, circulation increases with each compression but slows with even a momentary interruption.

Cardiac arrest–when the heart ceases to beat–can occur as a result of a heart attack, an abnormal heart rhythm, electrocution or near drowning.
[SOURCE: Jamie Stengle, “Heart Association Offers New CPR Guidelines,” Yahoo News, November 29, 2005]

Health Shorts

Decmber 2005

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