Lowering Blood Pressure at a Risk
THE QUESTION: For some people with high blood pressure, lifestyle changes alone are not enough. It takes medication, and often a combination of drugs, to lower blood pressure enough to reduce their risk of heart disease. Might combining drugs have a negative effect?
THIS STUDY compared the risk of dying from heart disease among 30,219 postmenopausal women who took an ACE inhibitor, a beta blocker, a calcium channel blocker, a diuretic or some combination of these drugs to control blood pressure. At the start of the study, none of the women had heart disease. After about six years, women who combined a diuretic and a calcium channel blocker increased their risk of dying from heart disease by 85 percent compared with those using a diuretic/beta-blocker combination. There was little difference in risk between the ACE inhibitor/diuretic and the beta- blocker/diuretic combinations. Women who took only a calcium channel blocker had a 55 percent increased risk of death from heart disease, compared with those who took only a diuretic. Among those taking only ACE inhibitors or beta blockers, risks were similar to those taking only diuretics.
WHO MAY BE AFFECTED BY THESE FINDINGS? Older women with high blood pressure.
CAVEATS: The study was observational rather than randomized. The findings do not necessarily apply to younger women or to men.
BOTTOM LINE: Older women with high blood pressure should talk with a doctor about the risks associated with various combinations of blood pressure drugs.
FIND THIS STUDY: Dec. 15 issue of the Journal of the American Medical Association; abstract available online at jama.com.
LEARN MORE ABOUT treating high blood pressure at nhlbi.nih.gov and american heart .org.
Therapy for fatigued teens
THE QUESTION: Teenagers and tiredness go hand in hand. But something serious may be happening when the weariness doesn’t disappear with sleep and is accompanied by muscle pain, headaches and difficulty concentrating. Those could be signs of chronic fatigue syndrome. Might cognitive behavior therapy help young people with this disorder?
THIS STUDY randomly assigned 69 youths, 10 to 17 years old, who had been diagnosed with chronic fatigue syndrome to undergo 10 talk- therapy sessions over five months or to be placed on a waiting list for the therapy. Therapy included challenging the youths’ beliefs about the disorder as well as gradually increasing their activity level. About 60 percent of the therapy recipients reported feeling less-severe fatigue, compared with 21 percent of those on the waiting list. Sixty-three percent of those in the therapy group showed improvement in physical functioning, compared with 24 percent of the others.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Young people with chronic fatigue syndrome. An estimated half-million Americans have this disorder; the number under 18 is not known.
* CAVEATS: Results of the study are based on self-reporting by the participants. The number of participants was relatively small.
* BOTTOM LINE: Parents of a child with this disorder should talk with a therapist about cognitive behavior therapy.
* FIND THIS STUDY: Dec. 14 online issue of the British Medical Journal; article available by clicking “Online First” at bmj.com.
* LEARN MORE ABOUT chronic fatigue syndrome at kidshealth.org and mayoclinic.com.
Hard contacts may be better
THE QUESTION: More and more children are abandoning their glasses for contact lenses. What effect might different types of lenses have on nearsightedness (myopia), which typically develops in adolescence?
THIS STUDY randomly assigned 116 children, averaging 11 years old, to wear either rigid, gas-permeable contact lenses or soft contacts for three years. Based on annual eye examinations, myopia progressed 29 percent more slowly in children who wore hard contacts than in those who wore soft lenses. The eye became more oval-shaped – one of the causes of nearsightedness – among the soft lens wearers than among the others.
WHO MAY BE AFFECTED BY THESE FINDINGS? Children with myopia, which generally develops between ages 8 and 14.
CAVEATS: The study did not determine how many hours a day rigid lenses should be worn to slow myopia. Most of the benefit came during the first year, which suggests that the effect may not be permanent. Contact lens manufacturers Menicon, CIBA Vision and SOLA Optical helped fund the study.
* BOTTOM LINE: Parents of children considering contacts should talk with an eye doctor about the benefits of gas-permeable rigid lenses.
* FIND THIS STUDY: December issue of the Archives of Ophthalmology; abstract available online at archophthalmol .com.
* LEARN MORE ABOUT contact lenses and myopia at may oclinic.com and aoa.org.