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Study Homes In On Best Place to Monitor BP
We doubt Dorothy of Wizard of Oz fame was referring to blood pressure (BP) monitoring when she chanted, “There’s no place like home,” but a new randomized diagnostic study confirms that the sentiment applies.
Given that BP readings vary like the winds of a Kansas tornado, researchers set out to identify the setting in which commonly used methods of BP monitoring yield the most accurate results. The study included approximately 500 patients without a diagnosis of hypertension but with an elevated in-clinic BP. The researchers compared BP measurements in clinics and homes and kiosks—oh my!—against daytime readings from a 24-hour ambulatory monitor (ABPM)—the gold standard for diagnosing hypertension.
Home is where the heart is
If that sentiment is true, it’s no wonder home blood pressure monitoring (HBPM) prevailed in this study. While researchers found no significant difference in mean BP measurements between HBPM and ABPM, BP measurements at kiosks were significantly higher and measurements in the clinic were significantly lower than measurements taken via ABPM. Hmmm, that surprised us. See the authors’ theories on why the concept of white coat hypertension didn’t apply in that last finding.
Key take-home points
This study supports the USPSTF’s recommendation to confirm elevated in-clinic BP with either ABPM or HBPM before making a diagnosis of hypertension. However, the authors note the caveat that the tools used to “systematically collect and average home BPs (Bluetooth connectivity and a database for averaging BPs) are not typically available in primary care.” Unfortunately for now, universal access to this technology remains somewhere over the rainbow. In the meantime, clinicians can optimize accuracy and improve hypertension diagnoses by assessing multiple readings in a variety of settings.
Next up for researchers: tackling how a scarecrow without a brain can comprehend the complicated syntax of the English language.
Science Takes Sides in the Cat Vs Dog Debate
Researchers stoked the fires of a feud older than those between the Capulets and the Montagues, the Jets and the Sharks, and the Starks and the Lannisters. It’s the clash between cat lovers and dog lovers.
A prospective study examined the effects of cat ownership and dog ownership (each compared with no pet ownership) on disability and mortality risk in older Japanese adults. In 2016, more than 11,000 adults aged 65 to 84 completed questionnaires about their pet ownership. Researchers followed these participants for 3.5 years, collecting data on disability onset, mortality, and other health and demographic information. While neither pet conferred a lower risk of mortality, a clear winner emerged when it came to the risk of disability.
Chalk one up for the dog lovers
During the follow-up, 17% of the participants developed a disability, but the dog owners were half as likely as the non-dog owners to suffer this fate. Cats offered their owners no such protection. The authors suggest that the exercise required to walk and care for a dog can stave off frailty and disability. The social element of dog walking can also deliver a benefit—a dog on a leash is a magnet for stop-and-chats and smiles from strangers.
When feasible and desirable, adopting a dog may be an effective option for older patients looking to lower their risk of disability as they age. Although the results of this study validate the benefits of dog ownership, patients who prefer feline companionship have reason for optimism. A preliminary study showed that owning either pet for five or more years may be associated with slower cognitive decline in older adults. That’s something cat lovers and dog lovers can break bread over. If only Sansa Stark and Cersei Lannister had found similar common ground.
Greater height may be associated with greater risk of developing colorectal cancer (CRC). This may sound like a tall tale, but a new study has reinforced the growing body of evidence that a towering stature may be a risk factor for the disease. A team at Johns Hopkins conducted a meta-analysis of 47 studies—the largest of its kind—that included more than 280,000 cases of CRC. Because “being tall” is a relative term, the team compared height within groups.
In short, the tallest person in the highest percentile of height was 25% more likely to develop CRC than the shortest person in the lowest percentile. Applying their findings to the American population, the researchers estimated that men at least 6 feet 1 inch and women at least 5 feet 8 inches have an unfortunate 14% increased risk of CRC.
Why do tall people seemingly have a higher risk? One of the study’s authors suggests it’s because “adult height correlates with body organ size. More active proliferation in organs of taller people could increase the possibility of mutations leading to malignant transformation.”
The researchers concluded that tallness is a risk factor for CRC but not nearly as strong a factor as age or genetics. This study poses questions about the effect of height on other cancers and highlights the importance of guideline-based CRC screening.
Holy Smokes—Another Health Risk for Vapers?
ENDO END POINTS
Lately, science has been piling on its critiques of vaping like Simon Cowell assessing an uninspired audition. Study after study has exposed the concept of e-cigarettes as a healthier alternative to combustible cigarettes as nothing more than smoke and mirrors. In this latest study, researchers identified a correlation between e-cigarette use and prediabetes.
In an analysis of survey data (2016 through 2018) from the Behavioral Risk Factor Surveillance System (BRFSS), researchers calculated that 9% of the more than 600,000 participants reported both current e-cigarette use and a diagnosis of prediabetes.
Where there’s smoke, there’s fire
The results of this study may not surprise anyone. Like combustible cigarettes, e-cigarettes contain nicotine, which has a known association with insulin resistance. So, like combustible cigarettes, e-cigarettes may also link to prediabetes. And the upward trend of both vaping and prediabetes in the United States supports this study’s findings.
The belief held by many consumers that e-cigarettes are a safer alternative to combustible cigarettes seems to be going up in smoke. Your patients who vape may not be fully aware of the risks e-cigarettes pose to their health, despite mounting evidence. Consider sharing with them the continually expanding list of risk factors: impaired cognitive development, cardiovascular disease, chronic lung disease, and erectile dysfunction—and now, prediabetes.
Rapid-Fire COVID-19 Updates
COVID QUICK HITS
- A blood atlas of COVID-19 defines hallmarks of disease severity and specificity
- Real-world evidence shows Pfizer-BioNTech vaccine effective in kids, adolescents
- Masking still ‘important layer of protection’ for children: AAP
- Brain changes after COVID revealed by imaging
A Diet Patients With IBS Can Stomach
Moving next to your parents to help with childcare seems like a win, but as Everybody Loves Raymond taught us, it may not be optimal long term. Well, researchers in this next study feel similarly about dietary interventions for irritable bowel syndrome (IBS)—what good is an effective diet plan if it’s not feasible over time?
In a randomized trial of nearly 100 patients with non-constipated IBS, researchers compared a traditional diet with a gluten-free diet (GFD) or a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet (LFD). After 4 weeks on the assigned diet, the following percentages of patients saw a ≥50-point reduction in their IBS symptom severity score, which has been shown to represent a clinically significant improvement:
- 58% of those on the GFD
- 55% of those on the LFD
- 42% of those on the traditional diet
While the traditional diet finished third in symptom alleviation, it made up ground or tied in other areas. Participants assessed the traditional diet as easier on their wallets, simpler to shop for, and more manageable when eating out. Most likely for these reasons, slightly more patients in this group said they would continue the diet.
The authors concluded, “On balancing the efficacy and acceptability of dietary therapies, plus the demands they place upon healthcare services, we suggest traditional dietary advice be considered first.”
Given its feasibility, a traditional diet may be the best first-line option for patients suffering from non-constipated IBS. This diet typically includes reasonable portions of healthy food, adequate hydration, less alcohol, and fewer processed, gas-causing foods. The authors recommended reserving the GFD or LFD for specific individuals in accordance with patient preferences and dietician input. Individualized dietary plans from a specialist should always be on the menu.
Interested in more healthcare news? Here are some other articles we don’t want you to miss:
- Long-term diazepam treatment enhances microglial spine engulfment and impairs cognitive performance via the mitochondrial 18 kDa translocator protein (TSPO)
- Risk of cancer in regular and low meat-eaters, fish-eaters, and vegetarians: a prospective analysis of UK Biobank participants
- Meta-analysis of 15 studies reports new findings on how many daily walking steps needed for longevity benefit
- Associations between alcohol consumption and gray and white matter volumes in the UK Biobank
- Long or irregular menstrual cycles and risk of prevalent and incident nonalcoholic fatty liver disease
Morning Report is written by:
- Alissa Scott, Lead Author
- Aylin Madore, MD, MEd, Author and Editor
- Shira Page, RN, NP, Author and Editor
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Please note that the summaries in Morning Report are intended to provide clinicians with a brief overview of an article, and while we do our best to select the most salient points, we ask that you please read the full article linked in each summary for clarification before making any practice-changing decisions.
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