“Start where you are, use what you have, do what you can.” — Arthur Ashe
The American Family Physician, a journal for family doctors like me, annually publishes studies likely to impact our practices and patient care. I share these with you in case you wish to discuss them with your own doctor.
• A study of 19,000 patients with hypertension showed that taking blood pressure medication at night instead of the morning reduced cardiovascular events, stroke, heart attack, bypass surgery and heart failure by 45 percent. All-cause mortality was similarly reduced. Wow. And it’s a free intervention.
• Automated blood pressure cuffs gave lower and more consistent readings compared with ambulatory monitoring than manual cuffs. Get your automatic cuff today.
• Behavioral issues like anxiety are highly prevalent in primary care practice. Meta-analysis of 89 studies including more than 25,0000 patients showed duloxetine, pregabalin, venlafaxine and escitalopram were the most effective and best tolerated for generalized anxiety disorder.
• Furthermore, it was found that many patients don’t disclose behavioral symptoms to their doctors in sensitive areas of depression, anxiety and sexual or interpersonal problems. Please share if you have a problem.
• Pharmacological management of depression needs a trial of at least six weeks to achieve a 50 percent response rate and 32 percent complete remission. At 12 weeks, there was 68 percent response and 49 percent remission. Be patient when starting antidepressant treatment.
• Fasting is no longer recommended for checking lipid levels. Cholesterol levels were unaffected by fasting though triglycerides were slightly higher in the non-fasting state.
• Statin drugs were of no benefit as primary prevention for those 75 and older without known cardiovascular disease.
• It was a bad year to own stock in aspirin. Three studies advised against its use in otherwise healthy older adults even in those with hyperlipidemia, hypertension and diabetes. Marginally improved heart attack rates were outbalanced by increases in hemorrhagic stroke and gastrointestinal bleeding.
• For colon cancer screening, the FIT test compares favorably with colonoscopy without the dreaded prep and expense. Anti-inflammatory drugs including aspirin and oral anticoagulants didn’t affect the reliability of this easy-to-do test. If you have a family history of colorectal cancer, your risk of cancer is definitely increased, so riding the black colonoscopy snake is in your best interest.
• In these days of COVID-19, we’re concerned about community-acquired pneumonia. It turns out that normal vital signs and a normal lung exam rule out pneumonia in 99.6 percent of patients, reducing unnecessary chest X-rays.
• Five days instead of 10 of penicillin is adequate for strep throat.
• Colds in children may persist for three weeks, so be patient with your precious snot-gurglers.
• Apixaban was the safest oral anticoagulant with lowest rate of gastrointestinal bleeding, potentially reduced further with a proton pump inhibitor antacid.
• Low doses of ibuprofen work just as well for acute pain as high doses.
• The new Shingrix vaccine works better than the previous Zostavax for shingles prevention.
• Finally, regular, moderate exercise three to five times weekly helps prevent falls.
That’s the news on the primary care front. Be well.