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Anchor lead: If you only have high blood pressure when you’re in your doctor’s office you may still be at risk, Elizabeth Tracey reports

Many people see their blood pressure go up when it’s measured in the doctor’s office, only to fall again once they’re elsewhere, a phenomenon called ‘white coat hypertension.’ Now a major new study from Spain suggests that even though this blood pressure falls, people may still be at risk for cardiovascular events. Seth Martin, a cardiologist at Johns Hopkins, comments.

Martin: White coat hypertension is when in clinic you get a high blood pressure, these are the folks who on the 24 hour pressure monitor will have normal blood pressures yet it turns out that they’re also at risk so it’s not a benign condition. How we actually treat that from a blood pressure standpoint is tricky, because if the blood pressure is truly normal over time well then, what are we really do about that? Is this a situation that we need to learn how to manage stress better or is this is situation where we actually need to treat the blood pressure directly? :30

Martin says this may be where measuring blood pressures multiple times over 24 hours or at intervals over weeks or months may be helpful, and looks forward to a day soon when an app can help. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: High blood pressure may escape detection in the doctor’s office but be very risky, Elizabeth Tracey reports

Masked hypertension describes the case where a person’s blood pressure is normal while in a physician’s office, but is high elsewhere. A recent very large study in Spain using 24 hour ambulatory blood pressure measurements identified this group who had previously gone undetected. Seth Martin, a cardiologist at Johns Hopkins, says strokes and heart disease may occur most often among this group.

Martin: This masked hypertension group did surprise me that this group was very high risk. This is a group where in clinic you miss the high blood pressure, you find a normal blood pressure in clinic but in fact if you were to look at their blood pressures over time outside clinic they have high blood pressure. I think this requires further study but clearly this should be signaling to us that we need to pay more attention to this group and really this shows the value of getting these blood pressures outside of clinic because we miss these people if we don’t.  :31

Martin believes this study will change practice so that measuring blood pressure over 24 hours will be much more common. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Measuring blood pressure over 24 hours while someone is out and about may be the best way for many, Elizabeth Tracey reports

Blood pressure measurements are both more accurate and helpful when measured over 24 hours while someone is going about their daily activities, a very large study from Spain reported recently. Seth Martin, a cardiologist at Johns Hopkins, applauds the results.

Martin: This study focused on ambulatory blood pressures over 24 hours, and they found that these are a better predictor of events, of risk, that is the impact of their blood pressure on their health outcomes. So I think the next step is to look at blood pressures over time, over months, over years, and how that links to health outcomes. I would predict that we’re going to spend more of our attention adjusting therapy to those ambulatory blood pressures than we will to those clinically taken blood pressures in the future.  :31

Martin says the devices to do so-called ambulatory blood pressures are also smaller, more durable and accurate than ever, so such a strategy is also practical. He looks forward to the day when an app may be able to provide the same functions. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Programs providing support for children benefit us all, Elizabeth Tracey reports

Social support programs are in the crosshairs when it comes to government cost-cutting, particularly those for children, but a recent report demonstrates that such strategies don’t work out in the long term, for individuals or society. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says the numbers are persuasive.

Davidson: What this article clearly identified for every dollar that you spend on a child you will reap seven dollars for that investment. Because if we don’t invest in children, if we don’t invest in social determinants of health, people are not going to be positively engaged in society. And we know many of the challenges that we see in society, from violence to the opioid epidemic, are symptoms of marginalization and alienation in society.  :29

Davidson urges everyone to take part in protecting not just healthcare for children, but education and other programs to assure that they are able to grow into their full potential. At Johns Hopkins, I’m Elizabeth Tracey.

 

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Anchor lead: How long should someone take an antidepressant? Elizabeth Tracey reports

A recent report cited troubling symptoms for some people when they stop taking antidepressant medications. Ramin Mojtabi, a psychiatrist at Johns Hopkins who assisted in the report’s data analysis, says for short term treatment, there are guidelines.

Mojtabi: If you go to practice guidelines they would recommend continuing these medications after starting between six and nine to twelve months for people who have experienced say one episode of depression. For long term treatment the guidelines are generally silent.  :17

Mojtabi says the research record is also lacking.

Mojtabi: There are no trials that have looked at the long term effect of these medications or long term benefit of these medications.  :08

Mojtabi says there are likely many people who simply stay on antidepressant medications because of their concerns about a recurrence of depression symptoms, but notes that a careful review of medication use with a provider is prudent, with a plan for cessation. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How troubling is it to stop taking an antidepressant? Elizabeth Tracey reports

Some people who take medicines to combat depression experience a range of troubling symptoms when they stop, a recent report found. Ramin Mojtabi, a psychiatrist at Johns Hopkins who contributed to the report, says a range of effects have been noted.

Mojtabi: We know based on anecdotal reports, we know based on our experience with patients that patients experience reporting nausea, headache, and electrical jolt, sometimes they talk of it as brain zap.  :15

Mojtabi says these are not withdrawal symptoms, since no dependency occurs.

Mojtabi: Discontinuation syndrome or discontinuation symptoms is a better description of what some people experience who try to stop their antidepressant medications. :11

Mojtabi says while rare, some people may experience symptoms of discontinuation that may last for months or even longer. He notes that anyone who is considering stopping an antidepressant should talk with their provider. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can eating a Mediterranean-type diet improve cancer survival? Elizabeth Tracey reports

People with colon cancer who had been treated for their cancer and who consumed a healthy diet, were physically active and practiced other healthful behaviors lived longer without a cancer recurrence than those who did not, a recent study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the study.

Nelson: Their questionnaire sampled tendencies for what people ate, habits vis a vis exercise and their weight and body mass index. They generated a score as to how concordant these lifestyle features were with the American Cancer Society guidelines for a healthy lifestyle and if you were very concordant with that 85% of those folks were alive and free of disease at five years. If you were poorly concordant with it 76% were alive and free of disease at five years.   :33

Nelson says this study did not account for how healthfully people lived before their cancer diagnosis, and says the definitive answer will emerge with prospective trials, currently underway. At Johns Hopkins, I’m Elizabeth Tracey.

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