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Beta Blockers Might Not Be Good First Line Therapy For High Blood Pressure

A new study in the Journal of the American College of Cardiology (August 14th issue by Bangalore et al.) questions the evidence behind using beta blockers as fist line therapy for high blood pressure.  It seems that these medications may actually increase the risk of stroke, especially in the elderly population.  The following drugs are all beta blockers:

  • Atenolol (Tenormin)
  • Metoprolol (Lopressor, Toprol-XL)
  • Propranolol (Inderal, Inderal LA)
  • Carvedilol (Coreg)

As many as 60 million Americans have high blood pressure, and many of them are currently taking beta blockers.  I asked Dr. Frank Smart, chairman of the department of cardiovascular medicine at Atlantic Health in New Jersey, what he thought of this new study.

1.  What is a beta
blocker?

Beta blockers are a class of drugs that exert their effects on the heart by blocking the effects of adrenaline.  This results in a slower heart rate and reduced blood pressure.  They can also protect you from rhythm disturbances.

2.  What did this study show?

Beta blockers have a lot of important uses, but this analysis shows that they’re not as effective as (and may have more side effects than) other therapies for the treatment of high blood pressure.  In the past, we physicians thought, “Well, shucks, if beta blockers are good to use after a heart attack, and people with high blood pressure are at risk for having heart attacks, then maybe we should use a beta blocker to treat the blood pressure.”  This study contradicts this thinking, suggesting that the beta blockers are inferior to other therapies.  In other words, we should use beta blockers for the conditions that they’re known to be good for, but we should not infer that they are best for blood pressure management when there are better drugs available.

3.  Will the findings of this study
change your practice?

Yes they will.  I’m one of those people who have used beta blockers on occasion to treat high blood pressure in patients whom I thought were also at high risk for heart attack.  I probably won’t use beta blockers as first line treatment in those individuals anymore.  I’m going to stick with diuretics or renin-angiotensin system blockers.

4.  What do these findings mean for
people with high blood pressure?

It means that they should follow the guidelines indicated for the treatment of high blood pressure.  It involves a step-wise approach, with diuretics being that first step.  Any therapy is better than no therapy, and controlling high blood pressure is critically important, but beta blockers (as a monotherapy) are probably not as good as other treatments.

5.  When would you recommend the use of
beta blockers?

Beta blockers are a very important class of drugs for many cardiovascular diseases.  Anyone who’s had a  heart attack needs to be on a beta blocker, anyone who has congestive heart failure (CHF) and can tolerate a beta blocker should be on one, and hypertrophic cardiomyopathy requires treatment with beta blockers.  Beta blockers can control certain heart rhythm disturbances, and can reduce the risk of adverse cardiovascular events during surgery.

6.  What’s the take home message from
this study?

When treating high blood pressure, we should use drugs that have been shown to have the greatest reduction in mortality.  Don’t assume that the valuable effects of beta blockers (for people who’ve had heart attacks) automatically translate into benefits for people with high blood pressure.

Want to hear the full conversation?   Listen to the podcast with Dr. Smart

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Racing in Stilettos – Job Security for Podiatrists

Russia has been promoting a new sport: the stiletto heels sprint.  Although I’d heard of this a couple of months ago, I just noticed some video footage on Yahoo! In this particular race, over 200 women turned out to run 1 kilometer (about 2/3 of a mile) in heels that are at least 3.5 inches high.

It is well known that regularly wearing high heels can result in foot deformities such as bunions and corns.  And yet women continue to wear them as they never seem to go out of fashion.  If you’re unwilling to give up those heels, but would like to avoid having feet that look like this, here are some tips for you:

1.  Minimize the distance you walk in heels.  Carry your shoes to work with you and wear flats or sneakers during most of your walking.

2.  Wear shoes that are wide in the toe box and do not squeeze your toes together.

3.  Put metatarsal pads in your high heeled shoes, to keep your foot from sliding forward  (especially if they are closed-toe).

4.  Don’t wait too long to see a rehabilitation medicine specialist or podiatrist if you think you’re developing a bunion.  Corrective action should be taken as early as possible.

5.  If you’re working at your desk, remember to slip off your shoes to reduce the pressure on your toes.  Every lit bit helps when it comes to reducing toe joint stress.  If your relatives have bunions, you may be at higher risk for developing them too.

As for those Russian women who race in their stilettos, all I can say is that they’ll be keeping the rehab docs, orthopedists and podiatrists in business!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

In Case of Emergency: Text Messaging Is The Best Mode of Communication

An emergency medicine physician friend of mine sent me a link to a fascinating article about why cell phones aren’t good communication devices in major disasters like 9/11.  When I was in NYC during 9/11 my cell phone didn’t work (the lines were all busy).  Here’s what the article had to say:

“So why do text messages get through when phone calls can’t? For one,
SMS text messages are very short, so they require very little capacity
when they are transferred over the network. The second reason is that
text messaging works by allowing messages to be stored and sent through
the network.

If there is a delay in connecting to the network, the phone will
store the message in its memory and it will continue attempting to send
the message until it gets through. By contrast, voice is a
delay-sensitive application. If a sustained connection can’t be made,
the person on the other end won’t be able to understand what you are
saying. And so the call cannot be completed.

While it’s quite common for cell phone networks to get overloaded
during serious emergencies, there isn’t much that can be done to fix
the problem. The main reason is that it just isn’t economically viable
for carriers to build their networks to handle a tenfold increase in
capacity in every inch of their footprint.

“People have to remember that this is a commercial service,” Golvin
said. “It was never designed to be an emergency network. And it just
doesn’t make business sense for carriers to try to build it that way.”
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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