Top 5 important information about Hypertension

I frequently meet patients being treated for Hypertension but inadequately informed or shall I say inadequately educated about their disease condition. This lack of important information can lead to a chain of problems like noncompliance to medications and therefore poor control of blood pressure. These are the top FIVE issues that are often overlooked by many physicians taking care of their hypertensive patients.

1. Hypertension must be understood as equal or above 140/90mmHg taken at rest. Elevated blood pressures taken during stressful situations i.e. emotional, mental or physical stress should not be qualified as these are stressors associated with a normal (physiologic) increase in BP. Normally BP returns to normal when the stress condition has been resolved.

2. Hypertension has a genetic predisposition in more than 90% of the time. In short, this is a genetic problem that we inherit from our parents and blood related relatives.

3. Since hypertension is an inherited disease, doctors can only prescribe medications to control and NOT CURE. It is in this light that your medicine therefore, needs to be taken for life in most cases. BP control is very important as it has been shown to reduce the risk of Congestive Heart Failure, Stroke and Heart Attack.

5. You must ask your doctor the most common side effect that is unique to the drug you are taking. Doctors often miss out on this information which I consider as vital. I have seen so many patients coming to see me for a simple side effect that would have prevented undue stress to them had they been forewarned. Example: Leg swelling is common for Calcium Channel Blockers, or electrolyte imbalance with diuretics and headache for ARB's (Angiotensive Receptor Blockers) not to mention cough that may affect roughly about 10% of patients taking ACE-Inhibitors.

If you have more questions about your condition feel free to ask your physician on your next visit to your doctors office.

Calcium Supplements can break your heart!!

Calcium supplements taken to reduce the risk of fractures from osteoporosis among elderly women has been found to be associated with a 30% risk of developing myocardial infarction (heart attack) according to a recent study published in the British Medical Journal published July 30, 2010.

This study result showed that the use of calcium supplementation amongst our elderly women to reduce the risk of fractures should therefore be reconsidered. Previous trials on the calcium supplementation through changes in diet does not increase the incidence of cardiovascular side effects seen in exogenous calcium supplementation suggesting that perhaps these adverse effects maybe limited only to orally taken calcium supplements.

This finding is in keeping with what we already know with most other studies on the benefits of supplements including antioxidants where no documentation of benefit were seen when these supplements taken orally in a tablet form.

A good and balanced diet remains superior to any attempts to supplement in the hope of boosting your health........so the next time you pop in your vitamins?.........think again and ask yourself.........is this really good for the body? or just for the mind?

As a physician I see these everyday and I always have reservations against supplements and my patients can attest to that.........this study just affirms and has been consistent with my beliefs!

Common misconceptions about EGGS!

Fact: Eggs are a good source of nutrients. One egg contains 6 grams of protein and some healthful unsaturated fats. Eggs are also a good source of choline, which has been linked with preserving memory, and lutein and zeaxanthin, which may protect against vision loss.

Fact: Eggs have a lot of cholesterol. The average large egg contains 212 milligrams of cholesterol. As foods go, that’s quite a bit, rivaled only by single servings of liver, shrimp, and duck meat.

Myth: All that cholesterol goes straight to your bloodstream and then into your arteries. Not so. For most people, only a small amount of the cholesterol in food passes into the blood. Saturated and trans fats have much bigger effects on blood cholesterol levels.

Myth: Eating eggs is bad for your heart. The only large study to look at the impact of egg consumption on heart disease—not on cholesterol levels or other intermediaries—found no connection between the two. In people with diabetes, though, egg-a-day eaters were a bit more likely to have developed heart disease than those who rarely ate eggs.

If you like eggs, eating one a day should be okay, especially if you cut back on saturated and trans fats. Other ways to enjoy eggs without worrying about cholesterol include not eating the yolk, which contains all the cholesterol, or using pourable egg whites or yolk-free egg substitutes.

A final word of caution however, is that if you have a strong family of heart disease the ill effects of eating high cholesterol foods like eggs may be detrimental to your health.

Eggs Galore.....

Limiting egg consumption has little effect on cholesterol levels, research has confirmed. A University of Surrey team said their work suggested most people could eat as many eggs as they wanted without damaging their health." The researchers said that previous warnings to limit egg consumption are "based on out-of-date evidence," and "eating saturated fats was far more likely to cause health problems." Researcher Professor Bruce Griffin said, "The ingrained misconception linking egg consumption to high blood cholesterol and heart disease must be corrected.

What Now for Vytorin? In? or Out?

Not too long ago Vytorin which is a combination of simvastatin and ezitimibe was lambasted after a negative study with the ENHANCE trial showing no proof of plaque regression despite a significant reduction in LDLc. It may have been a faulty study for which I think the study investigator maybe pushing this drug too much that their baseline thickness of the carotid intima maybe considered normal to start with......how can you expect further improvement when your baseline is already almost normal? It would have been better if they looked at a longer term trial comparing reduction of LDLc with inhibition of plaque progression rather than regression. I have always deep inside me believe that this was a flawed trial right from the beginning and I have continued to use the drug most importantly to my severely hyperlipidemic patients waiting for more proofs.

In medicine, our dictum is to do no harm. We have not seen harm done on patients with vytorin...that one study showed us that it " may " not be doing what it is supposed to do. We also need to mention that Simvastatin which is the statin component of vytorin has tons of proofs for the benefit our patients get from the drug hence, it just does not make sense why additional reduction of LDLc could hurt our patients?

Recently, the SANDS trial ( Stop Atherosclerosis in Native Diabetes Study) published in the Journal of the American College of Cardiology December 2008, a 36-month study, looking at regression in carotid intima in the diabetics showed that aggressive LDL reduction with ezetimibe + a statin or statin alone noted in patients with Type 2 diabetes mellitus was associated with a similar regression in carotid intima thickness. This is surely a a positive news and a welcome respite for this drug and a good reassurance not only to the medical practitioners but patients alike who got confused with earlier study results.

State of the Art in Cebu!

Finally the wait is over, our patients can now avail of the state of the art technology right at the heart of Cebu City. As Director of the Cebu Doctors' University Hospital Cardiac Catheterization Laboratory, I am proud to introduce our new GE Innova 2100 Flat Panel cardiac catheterization machine. This state of the art laboratory being made available to patients in the Visayas and Mindanao.

Cebu Doctors' University Cardiovascular Center is considered to be the most active cardiovascular center in Cebu City. This new laboratory would embolden our patients to take the right choice for their cardiovascular needs because they know we don't take their health for granted investing in high end machine to provide accurate and reliable result. We do various procedure including left and right heart catheterization, pacemaker implantation, hemodynamic studies, coronary angiography as well as percutaneous coronary intervention including surgical coronary bypass procedures, valvular replacements and many more.....

For more information, comments, or inquiries, please email me at: EdgarTan62@yahoo.com.

PCI vs CABG: Is it really an option?

In the real world, coronary disease remains to be the most prevalent cause of cardiovascular mortality and morbidity. The treatment options have continued to evolve especially with the rapid advances in percutaneous intervention blurring the difference between which form of therapy is better for a particular patient. The evolution of drug-eluting stent blurs the once mighty benefit of surgical bypass to the issue of lower incidence of repeated intervention rather than the hard end points of myocardial infarction and death.

PCI saves lives in acute coronary syndrome, these are patients brought to the emergency room with acute chest pains due to ischemia.

PCI has never been shown by various studies to be superior to optimal medical therapy in preventing MI in the stable patient. PCI in the setting of stable patient is best reserved for those that remain symptomatic inspite of maximal medical therapy.

Diabetics are a special group of patients at risk for repeated intervention if percutatneous intervention is employed hence, diabetics as a rule are best served with coronary artery bypass surgery rather than PCI. There are always exeption to the rule hence, an office discussion with your physician maybe warranted in this regard.

I will be giving a talk on revascularization options for patients with coronary artery disease during the Philippine Heart Association Post Graduate course on February 8, 2008 at the Waterfront Hotel, Cebu City. Feel free to email me at EdgarTan62@yahoo.com for any quesitons.