Birth Control Pills (BCP) and Eye Issues

December 15th, 2014  |  The Blog

With there being 62 million women of childbearing age in the U.S., there are a lot of birth control pill prescriptions written each year. More than 27% of all contraceptive users are those who choose the birth control pill. Birth control pills (BCP) are a popular prescription.

Recently, the American Academy of Ophthalmology (AAO) presented research stating that women who took the pill for 3 or more years had double the risk of developing glaucoma, years later.

Glaucoma Facts

Glaucoma is an eye disease that can lead to blindness. This research finding set many women who had been taking the BCP into panic mode.

The average woman over 40 years old has a 2% chance of developing glaucoma in her lifetime. The AAO research findings elevate that risk to 4% if someone has been on BCP for 3 years or longer.

Interestingly, women who did not get their first menstrual period until after age 13 have an 11% increased risk of developing glaucoma, whether or not they choose to use the BCP for contraception in later years.

The African American female population has inherent risk factors for glaucoma so should discuss personal contraception choices with their physician. This advice also stands for those women who have a family history of glaucoma.

Other Factors in the Study

There were other factors stated in the study that could potentially increase a woman?s glaucoma risk. They include:

  • Income level
  • Pregnancy history
  • General health

The study did not compare risk factors based upon any specific dose of hormone therapy in the BCP taken by the participants. The information asked in the study was whether the woman took BCP for 3 or more years or not.

It is important to note that women who took BCP many years ago where likely given a higher dose of hormones per pill than is delivered in the newer formulations. Therefore, the risk of glaucoma could be dose induced because estrogen, a hormone in BCPs, is known to affect the eye?s optic nerve.

One More Study

There was another study conducted by the Brigham and Women?s Hospital in Boston, MA, which supports the increased risk for developing glaucoma for woman who take BCP for 5 years or longer. This study states that the risk is a higher 25% but that it decreases the longer a woman is off the BCP.

What Now?

The researchers in both groups state that there is much more research to be dome on the subject of glaucoma and the birth control pill. Stopping the BCP is not the recommended route for the short term. Unwanted pregnancy can result, which presents another myriad of issues, good and bad. It is important for every woman on taking the BCP to discuss concerns with her physician. It is also important to have regular and comprehensive eye examinations with a qualified ophthalmology specialist.

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Prostate Surgery versus Watchful Waiting

December 11th, 2014  |  The Blog

Prostate cancer is the most common form of cancer in men, other than skin cancer. It is the second leading cause of cancer death in men, other than lung cancer. These are alarming statistics.

According to the American Cancer Society (ACS), there are 233,000 new cases annually in the U.S. That said, close to 30,000 American men will die from the disease in any given year.? These startling statistics translate into the fact that 0ne in seven men will be diagnosed with prostate cancer during their lifetime.

The Good News

Despite the alarming prostate cancer statistics, most cases of prostate cancer are not terminal. There are at least 2.5 million living American men who carry a prostate cancer diagnosis.

Treatment Options, Specifically Surgery vs Watchful Waiting

According to a Swedish study, surgery to remove the prostate definitely saves lives versus watchful waiting. This is especially true in men whose prostate cancer is truly symptomatic.

That said, some physicians warn the public that immediate surgery is not always a necessary treatment option for prostate cancer, especially those diagnosed early with a slow-growing tumor.

What is watchful waiting? This option is when a man diagnosed with prostate cancer is not aggressively treated unless the disease progresses. The benefit of watchful waiting is to avoid the often-debilitating effects of surgery and/or radiation therapy, which include urinary incontinence and erectile dysfunction.

The Current Recommendation

Cancer centers like Boston?s Dana-Faber routinely offer a version of watchful waiting called active surveillance. This involves monitoring the prostate-specific antigen (PSA) levels and a yearly prostate biopsy in men over 65 years old with early, non-aggressive prostate cancer that is not likely to be their cause of death. Some institutions are looking at dropping the active surveillance age to patients younger than 55 years old but the medical community is struggling with where the actual cut-off age should be.

Assessing whether the disease is life-threatening or not in each case is a difficult task. While active surveillance is targeted at the older affected male population, some younger men also wish to delay treatment, rather than undergoing aggressive cancer care. This is an individual and personal plan of care to treat a too common disease in the United States.

The ultimate goal of watchful waiting or active surveillance is to reduce over-treatment in men with low-risk prostate cancer while still working to control and obliterate the disease.

The bottom line recommendation derived by the study is two-fold:

  • Early prostate cancer usually takes decades to kill a patient
  • Prostate cancer treatment should be tailored to the patient?s life expectancy.

Therefore, patients with a life expectancy of about 20 years should consider more aggressive treatment than those with a shorter life expectancy.

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The Skinny on Belly Fat

December 3rd, 2014  |  The Blog

Belly fat is so annoying. It is not pretty and certainly not healthy. That said, it is also the toughest of fat collections to shed. Sometimes, a little explanation helps to decipher the code on how to get rid of some of the excess belly fat.

It is important to note that there is no single cause of belly fat. A combination of genetics, diet, age and lifestyle all contribute to the potential problem.

Who Has the Most Belly Fat?

Males have more belly fat than women. Women younger than 40 years old carry most of their body fat in the hips, thighs and buttocks. When estrogen levels drop, after 40 years old, most women’s body fat redistributes to the belly area.

Some Important Facts

Here is some important information about belly fat:

The Danger

Excess belly fat is unhealthier than fat that sits around the hips and thighs. Belly fat is associated with:

  • Heart disease
  • Stroke
  • Type 2 diabetes
  • Dementia and Alzheimer’s disease
  • Colorectal cancer
  • High blood pressure
  • Osteoporosis
  • Metabolic syndrome

Genetics determines some of a person’s body type, as do lifestyle choices, so most people have to work at keeping the belly fat to a minimum.

Food and Drinks

High-fat foods and high-caloric foods expand the waistline and contribute to belly fat.

Alcohol intake specifically targets a growing waistline. When alcohol is consumed, the liver works hard to burn off alcohol and, in turn, does not burn off fat. Alcohol intake also enhances the appetite. Both of these things contribute to a growing waistline.

The best way to eat and drink to reduce belly fat is:

  • Read food labels and know what you are eating
  • Reduce saturated fat intake and increase monosaturated fat intake
  • Reduce portion size
  • Avoid high-fat, high-calorie, super-sized fast food
  • Increase the amount of produce, fruit and vegetables, which you eat
  • Drink diet beverages, not regular soft drinks
  • Eat more protein and fewer carbohydrates

How to Fight Belly Fat

Food and Drink

  • Drink green tea. It contains catechins, which help the body burn calories and lose belly fat
  • Eat blueberries. They helped to reduce belly fat in rats, which offers promise for people
  • Eat a high-fiber diet
  • Eat whole grain foods, including air-popped popcorn
  • Include proteins like lean meat, fish, eggs and poultry as the foundation of a healthy and calorie-controlled diet

Exercise

Spot exercises strengthen the core but are not the solution to reduce belly fat. What works? Aerobic exercise, 30 to 60 minutes most days, is the best choice to reduce belly fat:

  • Running
  • Walking
  • Swimming
  • Cycling
  • Tennis

The answer sounds simple but takes commitment: Eat healthy and exercise regularly to reduce belly fat.

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How Much Produce Should You Eat?

November 26th, 2014  |  The Blog

Broccoli, cauliflower, carrots or green beans…vegetables come in all shapes, colors and textures. They are fresh from the field or flash frozen. They can be consumed cooked or raw. Vegetables are versatile.

Peaches, apples, grapes, bananas or pineapple…fruit also comes in all forms of sweetness or tartness. Fruit is most often consumed raw but is also cooked in many different recipe choices. Fruit can act as a snack, a dessert or an addition to a main course to vary the flavor and texture of the dish.

The Food Groups

There are five food groups to insure a balanced diet, which include:

  • Vegetables
  • Fruits
  • Grains
  • Dairy
  • Protein (meat, poultry, fish, nuts)

Together, vegetables and fruit comprise 40% of the food group list. They are important components of a healthy diet.

How Much Produce Should You Consume?

The U.S government recommends that adults consume 5 to 13 servings of fruits and vegetables a day. This recommendation has been challenged by a Harvard School of Public Health study, which finds that there are no additional health benefits if more than five servings are consumed a day.

The Facts

According to the Harvard study, each daily serving of fruit or vegetables a day lowers a person’s risk of dying from heart disease or cancer by 5% over a 25 year span. Do the math. Eating five servings of produce a day lowers the risk of dying by 25%.

The interesting fact is that eating six, seven, eight or more servings still only reduced the risk of dying by 25%.

The Benefits of Eating Vegetables and Fruit

Besides the wonderful flavors and textures of vegetables and fruit, there are many other benefits to being sure they are a regular part of a healthy diet. Some of the benefits include:

  • Reduce the risk of cancer
  • Reduce the risk of some chronic diseases
  • Provide essential vitamins, minerals and fiber necessary for good health
  • Naturally low in calories
  • Low in fat
  • Satiate hunger because they are filling

Try This Calculation for Precise and Personalized Intake

The U.S. government has developed a nutrition calculator site where the person’s age, sex and level of activity are entered. The site calculates the daily amount of produce that each person should consume.

An Important Note

There is no downside or harm noted from eating the extra daily servings of produce, that is, more than 5 or 6 servings a day. So, pile on the spinach, tomatoes, blueberries and pineapple.

The overall picture of a healthy diet includes, not only fruit and vegetables, but also other diversified plant-based foods. These include foods like nuts, legumes and whole grains. Each of these choices adds an additional variety of nutrients.

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When Should You Call the Doctor?

November 17th, 2014  |  The Blog

There is never a totally wrong time to call a doctor but there are definitely times when it is imperative to call one. What might those it is time to call the doctor moments be?

These guidelines are important for everyone, adults and children, but especially essential for parents to keep in mind when and if their child complains about any concerning symptoms.

The it is time to call the doctor symptoms include:

Difficulty breathing

  • Anyone with difficulty breathing needs to be evaluated.
  • A child who has rapid breathing or whose abdomen is sucking in around the ribs needs to be seen immediately.
  • If the patient is also pale or weak, along with the dyspnea, this warrants a 911 call, not a simple visit to a doctor’s office.

Fainting

  • Fainting has many causes such as dehydration and sometimes just sheer fear. If someone does not resume consciousness quickly, a 911 call is warranted.
  • Any fainting should ultimately trigger a call to the doctor.

Severe allergic reaction

  • A severe allergic reaction often starts with hives. Sometimes there is facial or lip swelling and difficulty breathing.
  • An EpiPen should be administered to anyone with a diagnosed allergy for whom it is ordered by a doctor. It is an immediate 911 call if an EpiPen is administered.

Excessive sleepiness

  • Difficulty waking a child or more generalized sleepiness can indicate an illness or potential poisoning and should be evaluated.

Bad pain, regardless where it is

  • Pain can be a sore throat, an earache, a headache or arm/leg pain after falling.
  • A doctor should evaluate any pain that does not go away in a short period of time.

Persistent vomiting and/or diarrhea

  • The source of persistent vomiting or diarrhea should be determined in case it is a serious problem.
  • Dehydration is also a great risk in this situation.

Burns

  • A blistered burn or one that looks black, indicating a severe injury, or white, indicating infection, should be seen by a doctor for the proper treatment.

High fever

  • A high fever with a child still acting generally okay is not as concerning as if a child stops eating and drinking, becomes listless and generally appears very ill.
  • If a fever over 102? F lasts more than one or two days, a visit to the doctor is advised.

Concussion

  • Not every bump on the head results in a concussion but if a patient becomes sleepy, confused or has trouble focusing on their usual activities, a concussion assessment should be done.

Bleeding

  • Unstoppable bleeding or a gaping, bleeding wound needs medical care.

The Guidelines

Pediatricians, especially, find themselves sometimes asking a parent why they waited so long to seek medical evaluation of their child. On the other hand, some parents repeatedly call the pediatrician and the physician wonders why a child was brought in for evaluation.

Key guidelines for calling a doctor include the specifics listed above but also some general thoughts listed below:

  • If what is happening is bad such as bad pain, bad bleeding or bad anything
  • If the symptom is not going away such as a lingering headache, a persistent rash, prolonged diarrhea or vomiting
  • If there is a gut feeling or instinct that something is wrong

So, there is no ultimately correct or wrong “time to call the doctor.” A level head should prevail in making an informed decision.

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Laughing Gas and Childbirth

November 12th, 2014  |  The Blog

Childbirth is approached with many different treatment options for the mother’s comfort. Some choose to go the natural route while others opt for an epidural spinal or, sometimes, pain medication. Read on to learn about another option.

There is a new, or actually renewed, treatment option to alleviate the discomfort of childbirth. As long ago as 1881, laughing gas was used in childbirth. In the 1930′s, using nitrous oxide during childbirth was fairly common. Shortly thereafter, options like twilight sleep, IV narcotics and epidural blocks stepped into the picture. These options were used for a long period of time during which nitrous oxide was no longer used. Everything old is new again even, sometimes, in medicine.

Laughing Gas and Childbirth

Laughing gas or nitrous oxide is currently and frequently used in countries, other than the U.S., during childbirth:

  • Canada, almost 50% of births
  • Australia, 50% of births
  • United Kingdom, 60% of births
  • Finland, 50% of births

Only 1% of U.S. hospitals have been using nitrous oxide during childbirth, according to a 2011 report. Currently, over 30 hospitals and birthing centers are offering or making plans and policies to offer laughing gas as a treatment option.

Nitrous Oxide Explained

What is nitrous oxide?

  • It is an odorless gas
  • It is a 50-50 mix of the gas and oxygen
  • It causes a dissociating effect in the brain that allows for less pain during childbirth

When can it be used?

  • It can be used at anytime during labor
  • It is self-administered through a mouthpiece as needed (Note: the nitrous oxide used in a dental office procedure s administered continuously) and easy to use
  • It is safe for the baby and the mother
  • At the start of a contraction, the patient inhales the gas so it has peak effect at the pinnacle of the pain; it wears off when the patient stops inhaling and is eliminated from the body in a few breaths

How does it feel?

  • The patient gets a little drowsy
  • It takes the edge off the pain but isn’t as much pain relief as an epidural
  • It reduces anxiety more than it delivering pain relief

What are the benefits?

  • It does not stop labor
  • It can be stopped or started at anytime

What are the side effects?

  • Nausea and vomiting
  • Lightheadedness, dizziness
  • Extreme drowsiness

Interesting fact

  • 35% to 40% of women who use nitrous oxide also get an epidural

Sometimes, just taking he edge of the pain off is enough to get a woman through labor and delivery of their baby. This innovative approach to childbirth is just what the doctor ordered.

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The Importance of Dental Floss

November 3rd, 2014  |  The Blog

The first question many dentists ask a patient is whether they floss their teeth daily. Do you?

Flossing is an important part of every oral health care plan, according to the American Dental Association. The daily oral hygiene practice should start as early as 2 years of age (or as soon as a child has two teeth that touch) and continue for a lifetime. The act should actually become a habit, a part of every person’s daily routine.

Benefits of Flossing

Dental floss cleans places where a toothbrush cannot reach. Flossing helps to prevent gum disease by removing pieces of food and plaque between the teeth.

Plaque is a sticky substance made of bacteria. The bacteria can irritate the gums and cause swelling or inflammation, which leads to gum disease. If that is not removed it can develop into tartar or calculus, a very hard material.

Types of Floss

In the early 1800′s, thin silk thread was first used for flossing. In the 1940′s, floss turned to nylon because it did not shred like the silk thread.

Current day floss comes in many options:

Waxed

This is nylon floss with a light wax coating, which makes it less likely to break. Waxed floss is a little more difficult to slip into tight spaces between teeth.

Unwaxed

This is thin floss consisting of 35 strands of nylon twisted together. It fits in between teeth that are close together but shreds or breaks easier than some other floss choices.

Dental tape

This option is wider and flatter than standard floss. It, too, comes in waxed and unwaxed versions. People with wider spaces between their teeth often find dental tape to be a good floss option.

Polytetrafluorethylene (PTFE) floss

PTFE is the material used in resilient Gore-Tex fabric. This floss option slides easier between teeth and does not shred as easily as standard dental floss. One brand of PTFE floss is Crest Glide.

Super floss

This option is made of a yarn-like material and has a stiffer section at one end, which can be used to clean around braces and bridgework.

Other choices

If standard floss does not fit the criteria to clean between teeth, there are other options like wooden plaque removers, dental picks and pre-threaded flossers.

How to Floss

Flossing should be done once a day, either before or after brushing, which should be done at least twice a day. Flossing before brushing is the usual recommendation so the fluoride from the toothpaste can get to the areas between the teeth. It is important to do a thorough flossing job.

Here are the simple steps to effective flossing:

  • Use 18″ of floss
  • Wrap most of the floss around the middle fingers of one hand and the remaining floss around the middle finger of the other hand
  • Grip the floss tightly between the thumb and forefingers so there is 1″ to 2″ of floss between the hands
  • Pull the floss tightly and guide it between each tooth, one at a time, using a circular motion
  • Once the floss reaches the gumline, guide the floss up and down against the sides of the teeth and under the gumline, scraping up and down to clean the area
  • Unwind fresh floss as needed

It is important to floss around each tooth and the sides of the teeth at the back of the mouth.

What to Expect

When flossing if first started, the gums might be tender and bleed. The bleeding will stop as the gums become healthier.

Any discomfort from initially starting to floss should lessen in a week or so.

An Interesting Fun Fact

The Guinness World Record title for flossing is held by a North Carolina elementary school. Here is what they did:

1,470 students, parents and teachers flossed for 55 seconds using a 6,000-foot piece of dental floss!

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Migraines by the Numbers

October 30th, 2014  |  The Blog

It is amazing how many people suffer from persistent headaches and often migraines. The statistics surrounding migraines is significant in the U.S.

According to the National Library of Medicine, a migraine is defined as:

A migraine is a common type of headache that may occur with symptoms such as nausea, vomiting, or sensitivity to light. In many people, a throbbing pain is felt only on one side of the head. Some people who get migraines have warning symptoms, called an aura, before the actual headache begins.

Migraines by the Numbers

  • 10% of the world population has had a migraine in the past year versus 47% who reported a typical, simple headache during the same time frame
  • 28 million Americans suffer from migraines

Physical Effects of a Migraine

  • 4 to 72 hours is the average duration of a migraine
  • 3% of Americans experience chronic migraines; chronic migraines are those that occur at least 15 days per month for at least 6 months
  • #8 ranking as the world?s most disabling medical condition

Most common migraine symptoms

  • 85% throbbing, pulsating pain
  • 80% Light sensitivity
  • 76% Sound sensitivity
  • 73% Nausea
  • 44% Visual changes or blurred vision
  • 36% Aura

Who Gets Migraines?

  • 25 to 55 years is the most common age range for migraine sufferers
  • 50% of all migraine sufferers experience their first migraine before 12 years old
  • 6% of all males in the U.S. suffer from migraines
  • 8% of all females in the U.S. experience migraines
  • Over 27 million women in the U.S. report having migraines
  • 3 times as many adult women as men have migraines; in childhood, there are more boys than girls who report migraines
  • 10% to 14% of American women report menstrual migraine; when the estrogen level rises, the risk and severity of migraines increases
  • 40% chance of a child developing migraines if one parent has a history of migraines
  • 90% chance of a child developing migraines if both parents have a history of migraines
  • 10% of school-age children get migraines
  • 1 in 4 U.S. households has someone who has migraines

The Lifestyle Effects

  • 3 million emergency room visits annually are attributed to migraines or headaches
  • Every 10 seconds, someone goes to a U.S. emergency room with a migraine or headache
  • 2 days before and up to 3 days after menstrual onset is the timeframe for a menstrual headache
  • 4.5 hours and 6 hours represent the time confined to bed for men and women, respectively, during a migraine
  • 3.8 days and 5.6 days spent in bed annually for men and women, respectively, with migraines
  • Over 112 bedridden days for the American migraine population
  • 113 million workdays are lost annually in the U.S. due to migraines
  • $13 billion is the cost to U.S. employees from lost workdays
  • $200 billion is the total cost of migraine care, which includes medical care, lost workdays and lost productivity

The Bottom Line

Migraines affect a wide range of the American population, probably more people than expected. They can be debilitating but with the proper combination of treatment choices, migraines can be managed.

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Tech Meets Healthcare with the Strep Throat App

October 20th, 2014  |  The Blog

The cold and season is approaching or actually active in some places. It is difficult to know at what point, if any, in the illness that medical evaluation is needed. Patients are often sent home with a proclaimed virus so are hesitant to even make the effort to get to the doctor.

One important caveat to note is that strep infections do not present in any specific season, they circulate among the population throughout the year.

Strep Throat Facts

Strep throat is caused by a bacteria, not a virus. The bacteria is called Group A streptococcus.

It is important to have a prolonged sore throat checked. Strep can evolve into a serious illness. How often is a strep test positive? Less than one in four strep tests, when a patient has a sore throat, prove the presence of the bacteria. The one in four positive cases results in about 10% of cases in adults and 30% in children.

So when is it the right time to go to the doctor? Boston Children’s Hospital has developed a risk assessment tool, which tracks a patient’s symptoms along with the incidence of strep infections in the area where they live. It will work in a similar fashion to the current flu tracker app.

The App

The new app, which is still in the throes of development, measures a home score, which is a combination of patient symptoms and demographic data regarding local strep throat activity. The score is calculated using these patient symptoms:

  • Patient age
  • Presence or absence of fever
  • Presence or absence of sore throat
  • Also incorporates the strep incidence in the geographic area

A low score indicates a low risk of the infection and potentially prevents an unwarranted trip to the doctor.

If the geographic area is rampant with strep and the patient presents with a combination of identified symptoms, the likelihood of having a strep throat is naturally increased. At this juncture, professional medical evaluation is warranted.

The app allows patients and parents of young children to make an informed decision about seeking further medical evaluation.

The Wrap-Up

A higher risk of having a positive strep test was noted in patients who have a sore throat with an accompanying fever but no cough. This patient population, especially those under 15 years old, should seek medical care. The American Academy of Pediatrics recommends that any patient under 15 years old with a sore throat should get it checked by a physician. This age group more commonly carries bacterial infections.

If the strep evaluation app is consistently used, it can potentially prevent about 230,000 doctor?s office visits annually. On the other hand, about 8,500 actual strep cases could also be missed.

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What is Hypertension?

October 14th, 2014  |  The Blog

Hypertension or high blood pressure is a serious medical condition, which warrants the attention of a qualified healthcare professional.? There are about 1/3 of Americans who are currently diagnosed with hypertension. Surprisingly, 90% of them developed hypertension after age 55.

High blood pressure can cause a stroke or other health problem, especially heart disease.

Hypertension Guidelines

There are relatively new guidelines to determine if a patient needs to treat their hypertension or not. The new guidelines will reduce the number of older Americans, specifically those over 60 years old, who take anti-hypertensive medicine.

First, let?s be aware of the 10-year-old recommendation to treat hypertension for those over 60 years of age. It used to be 140/90 mmHg.

A report in a recent Journal of the American Medical Association states that no medication is needed until blood pressure reaches 150/90. There is no benefit to keeping the blood pressure at 140, instead of 150.

The side effects associated with blood pressure medications taken by an elderly population are a far greater risk than of a 150/90 reading. The risks include dizziness and lightheadedness, which can lead to a fall and subsequent bone fractures.

Secondly, let?s look at the guidelines for diabetes of any age or those with kidney disease. The recommended blood pressure used to be below 130mmHG but the new guidelines suggest that below 140 mmHg is adequate.

Lastly, recommendations for the younger population remain unchanged. Blood pressure should be maintained at 140/90 or below for this group.

The First Line of Defense

Lifestyle changes should be the first line of defense in lowering blood pressure. These measures include:

  • Weight management
  • Reduced sodium or salt in the diet
  • Regular exercise
  • Relaxation techniques

If these things work, medications can be avoided. They should be continued even when anti-hypertensive medications are added into the medical regime.

Blood Pressure Medication

Cardiologists, primary care physicians or family practitioners regulate hypertension medications. The simplified guidelines are intended to keep the suggested treatments the same, across the board.

There are four classes of medications for high blood pressure. They include:

  • Diuretics
  • Calcium channel blockers
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin receptor blockers

Calcium channel blockers and ACE inhibitors are most effective at lowering blood pressure.

The Outcome

There remains a need to clarify the specific treatment protocols for patients who have issues beyond simple hypertension. Those who have congestive heart failure (CHF), coronary artery disease (CAD) and/or cardiac arrhythmias are not specifically detailed in the new guidelines.

Unfortunately, no major medical group issued the new guidelines so some cardiologists are concerned. The National Heart, Lung and Blood Institute (NHLBI), for unknown reasons, pulled out of the reporting process.

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