Due to the weather, some customers may experience late delivery of The Roanoke Times. We apologize for the delay.
Tuesday, June 4, 2013
In the 21st century, doctors pride themselves on practicing evidence-based medicine. Recent studies of treatment for hypertension suggest, though, that practice is sometimes influenced by belief and habit as much as by evidence.
Prescribing drugs for patients whose blood pressure is 160/100 or higher is well-supported by research that shows such treatment saves lives. What is less clear, however, is whether patients with milder hypertension actually benefit from drug treatment.
A systematic review of high-quality clinical trials by the independent Cochrane Collaboration revealed that antihypertensive drugs have not been shown to benefit patients with mild hypertension and no pre-existing cardiovascular disease (Cochrane Database of Systematic Reviews, Nov. 14, 2012).
Mild hypertension was defined with the upper number (systolic blood pressure) running between 140 and 159 and the lower number (diastolic blood pressure) between 90 and 99. Most physicians in the U.S. have been trained to treat patients with blood pressure in this range using medications.
British doctors, on the other hand, tend to be more conservative. A recent commentary by a London physician, “Waste and Harm in the Treatment of Mild Hypertension,” pointed out that treating such patients does not offer them any benefit but does pose risks (JAMA Internal Medicine online, May 13, 2013).
The author underscores the influence of the pharmaceutical industry on existing treatment guidelines. Lowering the threshold for blood pressure treatment has been called “disease creep.” It created 13 million new “hypertensive” patients in the U.S. overnight.
The physician who pioneered hypertension screening, Dr. Julian Tudor Hart, responded to the Cochrane analysis, “Why has it taken more than 30 years to reach this conclusion, when it was already evident from any careful and critical reading of the trials claimed originally to justify intervention in the diastolic range 90-100 mm Hg?”
People’s Pharmacy readers know that our first recommendations for lowering mildly elevated blood pressure usually are the nondrug approaches doctors refer to as therapeutic lifestyle changes (TLC). These include diet, exercise, relaxation therapies, smoking cessation, alcohol moderation and certain mineral supplements.
Following through on such lifestyle interventions is challenging, but it can lower blood pressure nearly as well as medication. TLCs do not trigger side effects and often have additional health benefits. Both the Mediterranean diet and the DASH diet (Dietary Approaches to Stop Hypertension) have strong evidence to support their positive influence on cardiovascular outcomes.
People often complain about dizziness or sexual side effects with blood pressure medicine. ACE inhibitors like lisinopril and ramipril can lead to persistent coughing that can be incredibly disruptive. One reader reported: “My doctor told me that the cough that developed a month after taking lisinopril could not be due to the medicine. He said it would have happened anyway. I was given an inhaler for asthma. After using it to no avail, I insisted that we change the BP medicine, and the cough disappeared.”
To practice evidence-based medicine, doctors need to keep up with the research and follow their oath to “First, do no harm.”
Q: You are worrying people unnecessarily about aluminum and Alzheimer’s disease. This myth was debunked years ago. Why are you still flogging a dead horse?
A: The controversy over aluminum exposure and brain toxicity has not disappeared. Recent research suggests that aluminum is linked to neurotoxicity and even dementia (Immunologic Research online, April 2013).
Aluminum is found in higher concentrations in the brains of Alzheimer’s patients (Journal of Alzheimer’s Disease online, Vol. 35, No. 1, 2013). There is growing concern that aluminum is involved in the development of this devastating condition (Clinical Biochemistry, January 2013). A preliminary study found that drinking silicon-rich mineral water helps remove aluminum from the body and may improve cognition (Journal of Alzheimer’s Disease, Vol. 33, No. 2, 2013).
We have interviewed some of the world’s leading experts on aluminum toxicity. To learn more about this rapidly evolving topic, you may wish to listen to a CD of our one-hour show “How Safe Is Aluminum?” To order, please send $9.99 plus $2 shipping and handling to: Graedons’ People’s Pharmacy, No. CD-869, P.O. Box 52027, Durham, NC 27717-2027. The MP3 also can be downloaded for $2.99 from our website: www.peoplespharmacy.com.
Q: I have heard for years that when your child has a cough, you should put Vicks on his feet. I thought that was ridiculous. On his chest, yes, but feet? So I hadn’t done that.
My son coughs until he starts to vomit whenever he gets even the slightest cold. He’s 7 years old and has a nasty virus right now, as do I.
I decided to try Vicks on his chest. I didn’t remember it working that well when I was a kid, so I hadn’t tried it before.
My husband said to put it on his feet. Still thinking it was silly, I put it on my son’s feet but not mine.
He slept all night with no coughing. I know because I would have heard him; I was awake most of the night coughing.
A: Camphor, eucalyptol and menthol, all found in Vicks, are approved OTC cough-medicine ingredients. Why applying this ointment to the soles of the feet could quell a cough remains a mystery.
Q: My doctor has recommended that I take enteric-coated aspirin to protect my heart without damaging my stomach. I have recently read that coated aspirin doesn’t always protect the heart as well as regular aspirin. Would I be safer buying low-dose chewable aspirin?
A: The study you are referring to was published in the journal Circulation (Jan. 22, 2013). Researchers gave 400 volunteers either immediate-release regular-strength aspirin or a similar dose of enteric-coated aspirin.
Some of the people taking coated aspirin had a much-delayed anti-clotting response. This may not matter for daily aspirin users like you. However, doctors may recommend uncoated or chewable aspirin for people who suspect a heart attack in progress.
Q: My husband has had rosacea and seborrheic dermatitis, with facial redness, flaking and discomfort. Prescription creams did not help, and some seemed to make the facial redness worse.
We read in your column that washing the face with selenium sulfide dandruff shampoo (Selsun Blue) might help. After one month, his skin is smooth, healthy and normal-looking. He looks years younger, and the discomfort has vanished.
A: Thank you for the testimonial. Perhaps the anti-fungal properties of selenium sulfide are responsible for this success.
“The People’s Pharmacy with Joe and Terry Graedon” airs Saturday at 7 a.m. on WVTF (89.1 FM) and at 4 p.m. Saturdays and Sundays on RADIO IQ (89.7 FM). Joe and Teresa Graedon’s column runs in Tuesday’s Extra.
Weather JournalMany very icy despite 'bust' claims