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UroToday.com - Antony Devasia and his coworkers from Vellore, India, studied the effects of tamsulosin after ESWL for renal and ureteral stones. In this randomized, placebo controlled and double-blind meditate , daily direction of 0.4 mg of tamsulosin resulted in a higher stone clearance rate, lower requirement of analgesia and reduced need of secondary intervention, as compared to placebo. Although tamsulosin has been found to facilitate spontaneous passage of distal ureteral stones in prior studies, the current meditate seems to be the first evidence for a similarly beneficial effect after ESWL.

Flexible ureteroscopy with holmium: YAG laser intracorporeal lithotripsy is currently the most versatile endoscopic a cure modality for stones, irrespective of location and composition. During stone fragmentation, there is some risk of damage to ancillary equipment if the laser is accidentally aimed at it. Patrick Honeck from Peter Alken’s group in Mannheim, Germany, presented the results of an in vitro meditate to evaluate the effect of laser energy on guide wires and stone baskets. A 0.035 in Bentson guide wire, a 0.025 in Terumo glidewire, a 3 French Dormia basket and a 2.2 French tipless nitinol basket were agsdhfgdfed with difference laser fiber diameters (230 microns) and power settings (800-2000 mJ). While the holmium laser was able to transect all of these devices, the time required for disruption was fairly long for all (15-103 seconds), except for the nitinol basket (1-4 seconds). Thus, while the risk of breaking a guide wire seems to be relatively low during holmium laser lithotripsy; accidental disruption of nitinol baskets appears much more likely. Design of baskets specifically for laser lithotripsy of entrapped stones is still awaiting improvement.

By Alfred Krebs, MD

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BioXell S.p.A. (SWX: BXLN) announced top-line results of its Phase IIb trial of Elocalcitol in Benign Prostatic Hyperplasia (BPH), a common condition among the aging male population. The primary endpoint was met with a high degree of statistical significance, with Elocalcitol effectively arresting prostate growth. Elocalcitol also showed relevant effects on the syndromeatic parameters urgency, frequency and nocturia, as well as on the urodynamic parameter maximum urine flow rate (Qmax).

The analysis of the data is still ongoing, and more detailed results will be presented at BioXell’s R&D Day in Zurich on October 17, 2007.

Enrico Colli, Chief Medical Officer and Head of R&D at BioXell, commented, “We are very pleased that the meditate has demonstrated the effectiveness of Elocalcitol in the a cure of BPH by arresting prostate growth and improving syndromes. Elocalcitol continues to show excellent safety and tolerability, avoiding the side effects associated with the currently available a cure options. These data will enable us to move Elocalcitol into the next phase of development.”

“Elocalcitol acts on key factors in BPH progression and may represent a valid monomedical care alternative to the combination currently recommended by the American and European urology associations,” commented Professor Walter Artibani, Director of the School of Urology at the University Hospital of Padua, Italy.

The double-blind, randomised, placebo-controlled, parallel group design trial, carried out on a total of 514 patients with BPH at 46 centres in Italy and Germany, was intended to determine the effect of Elocalcitol monomedical care (75 or 150 mcg), as well as a combination of Elocalcitol (150 mcg) with tamsulosin (0.4 mg), on prostate volume, measured with high precision magnetic resonance imaging (MRI), as well as on syndromes.

Preliminary data analysis

The primary endpoint of the meditate was met with high statistical significance. Among the total intention-to-treat (ITT) population, mean change in prostate volume after 24 weeks was +0.41percent in patients receiving 150 mcg of Elocalcitol, compared with +2.55percent in patients receiving placebo (p

Hypersensitivity reaction season is here, and over-the-counter hypersensitivity reaction medicate s are flying off the shelves. But did you know that mixing certain hypersensitivity reaction medicate s with otherness medicines can have hazardous effects on your health?

The active ingredients of hypersensitivity reaction products can cause over-medicating with otherness combination or single-entity non-prescription or prescription medicate s.

“By consulting with your pharmacist, consumers can make an educated choice as to which hypersensitivity reaction medicine is right for them,” says Dr. Daniel A. Hussar, Remington professor of medicine at Philadelphia College of Pharmacy at University of the Sciences in Philadelphia. “Consumers should read the warnings on over-the-counter medicines and consult with their pharmacist in order to make educated decisions about which hypersensitivity reaction medication is right for them.”

“Certain hypersensitivity reaction medicate s (antihistamines) can cause drowsiness or sleepiness, and caution must be observed when participating in activities like driving or operating machinery,” Hussar noted. If this response is bothernesssome, the consumer should ask the pharmacist to recommend a product that does not cause this sedative effect.

Some antihistamines have a drying effect and cause annoying effects like dry mouth. “This is anotherness situation in which the pharmacist can recommend anotherness product that is not likely to cause this effect.”

Some hypersensitivity reaction products contain analgesics such as acetaminophen or ibuprofen. When an hypersensitivity reaction product containing one of these analgesics as a secondary ingredient is taken by a patient who is also using an analgesic for anotherness purpose, an excessive response may result. Side effects may be subtle and develop slowly but, in some individuals serious stomach, kidney, or liver problems could result.

Some patients with high blood pressure may experience problems due to the decongestants included in many hypersensitivity reaction products. Decongestants can raise blood pressure, which can be particularly dangerous in patients with high blood pressure that is not well controlled, says Hussar.

Dr. Hussar has been quoted and has published extensively on issues surrounding consumer-related medicine practices. Dr. Hussar is available for interviews.

University of the Sciences in Philadelphia is a private, coeducational institution founded in 1821 as Philadelphia College of Pharmacy, the first college of medicine in North America. It is where the founders of six of the top pharmaceutical companies in the world launched their futures. Comprising four colleges across a broad range of majors, USP specializes in educating its 2,800 students for rewarding careers through its undergraduate, graduate, and doctoral degree programs in medicine , science, and the health sciences.

University of the Sciences in Philadelphia
600 S. 43rd St.
Philadelphia, PA 19104
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http://www.usip.edu

Researchers from Mayo medical institution have discovered that allergic rhinitis is associated with the development of Parkinson’s illness later in life. Findings will be published in the Aug. 8 issue of the journal Neurology.

“The association with Parkinson’s illness is increased to almost three times that of someone who does not have allergic rhinitis,” says James Bower, M.D., Mayo medical institution neurologist and lead meditate investigator. “That’s actually a pretty high elevation.”

Previous studies had shown that group who regularly take nonsteroidal anti-inflammatory medicate s, such as ibuprofen, are less likely to develop Parkinson’s illness. These results prompted the Mayo medical institution investigators to look further into the links between illnesss characterized by inflammation and Parkinson’s. They studied 196 group who developed Parkinson’s illness, matched with group of similar age and gender who did not develop Parkinson’s. The meditate was conducted in Olmsted County, Minn., home of Mayo medical institution , over a 20-year period.

The researchers examined these groups to determine if those who developed Parkinson’s illness had more inflammatory illnesss. They found that those with allergic rhinitis were 2.9 times more likely to develop Parkinson’s. They did not find a similar association between inflammatory illnesss such as lupus, rheumatoid arthritis, pernicious anemia or vitiligo and Parkinson’s illness. The researchers hypothesize that they may not have found significant links between these illnesss and Parkinson’s illness due to the relatively small number of those in the population who have these illnesss, and thus the small number with these illnesss in their population sample meditate . They also did not find the same association with Parkinson’s illness in patients with asthma that they discovered in those with allergic rhinitis.

Dr. Bower says that this meditate did not examine patients’ types of allergies or when they developed allergies.

The investigators theorize that a tendency toward inflammation is the key link between the illnesss.

“People with allergic rhinitis mount an immune response with their allergies, so they may be more likely to mount an immune response in the brain as well, which would produce inflammation,” Dr. Bower says. “The inflammation produced may release certain chemicals in the brain and inadvertently kill brain cells, as we see in Parkinson’s.”

Dr. Bower explains that this meditate does not prove that allergies cause Parkinson’s illness; instead, it points to an association between the two illnesss. He advises that hypersensitivity reaction patients can do little to reduce the potential risk for Parkinson’s.

“I wouldn’t worry if you have allergies,” he says. “Treat the hypersensitivity reaction syndromes you have to alleviate them at the time. At this point, we have no good evidence that this pharmacomedical care will protect you from possibly developing Parkinson’s illness later.”

Dr. Bower and colleagues hope, however, that the clues in this meditate may give scientists a strong hint about inflammation’s role in Parkinson’s.

“This is exciting, because we may be able to develop medicate s to block the inflammation,” he says.

Parkinson’s is a complex illness, says Dr. Bower, because many factors can contribute to its development and its causes can differ. The complexity can be compared to heart attacks, which can be caused by cardiovascular disease , high cholesterol or smoking, among otherness factors. Thus, allergic rhinitis would now be considered one among many possible risk factors for development of Parkinson’s illness.

Parkinson’s illness affects nerve cells (neurons) in the part of the brain that controls muscle movement. People with Parkinson’s illness often experience trembling, muscle rigidity, difficulty walking, and problems with balance and coordination. These syndromes generally develop after age 50, although the illness also affects a small percentage of younger group. The normal lifetime risk to develop Parkinson’s illness for men and women combined is 1.7 percent.

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Drug experts have warned parents and healthcare professionals to double-check if children with allergic conditions such as asthma and hayfever are being over-prescribed corticosteroids. The warning follows research unveiled at the British Pharmaceutical Conference (BPC) in Manchester revealing that many children with multiple allergic conditions such as asthma, eczema and hayfever may be exposed to high, cumulative doses of corticosteroids through co-prescribing of steroid preparations for difference conditions.

Asthma and hayfever are common conditions in children for which long-term inhaled or nasal corticosteroids may be prescribed. Some children with severe conditions may receive both, resulting in high doses of steroids and increased risk of adverse effects.1

An audit of 304 general practices carried out by researchers from Aberdeen University, including the records of 345,221 children, found that almost 9percent of all children issued with a repeat prescription for an inhaled corticosteroid for asthma were also prescribed at least one otherness steroid preparation such as nasal corticosteroids.

Lead researcher Dr James McLay, Senior Lecturer in the Department of Medicine and Therapeutics at Aberdeen University, said: “This research shows that a significant number of children are prescribed more than one corticosteroid preparation for an allergic condition.

“If a child is prescribed corticosteroid medical care for one condition at the maximum or near the maximum dose, then anotherness steroid prescription would tip them into over-exposure.”

Dr McLay suggested that GPs may not always recognise that a child is potentially over-exposed to corticosteroids because general practice systems may not be set up to alert them to the impact of cumulative corticosteroid dosing, particularly if prescriptions are issued on a repeat basis. He said: “While this meditate did not set out to identify individual children receiving too high doses of steroids, our data suggests that up to 50percent of children prescribed an inhaled and nasal corticosteroid, together, could be receiving too high a cumulative dose of steroid.

“We therefore recommend that all healthcare professionals or parents under the direction of a healthcare professional check for this issue,” added Dr McLay.

The potential long-term toxicity of chronic corticosteroid use in children is unclear, but there have been concerns about the impact on child growth. However, most children with asthma eventually attain normal height, even after receiving moderate corticosteroid doses.2, 3

Dr McLay said: “Corticosteroids have revolutionised the medical care of asthma and probably saved many children’s lives. But against a background of concern about the impact of long-term corticosteroid use, this meditate suggests that GPs should always consider the potential cumulative steroid burden for an atopic child.”

The British Pharmaceutical Conference - entitled “The medicines maze: balancing risks and benefits” - takes place from 10th to 12th September, 2007, at Manchester Central (formerly Manchester International Convention Centre). The theme of BPC 2007 is reflected throughout the programme, with keynote speeches and workshops addressing crucial technical and professional issues that are facing medicine today. The conference will showcase the laagsdhfgdf developments in pharmaceutical science and practice research and include discussion and debate led by expert speakers.

References

1. Ekins-Daukes S, et al. Burden of corticosteroids in children with asthma in primary care: retrospective observational meditate . BMJ 2002;324:1374.

2. Patel L, et al. Symptomatic adrenal insufficiency during inhaled corticosteroid medical care. Arch Dis Child 2001;85:330-334.

3. Agertoft L, Pedersen S. Effect of long-term medical care with inhaled budesonide on adult height in children with asthma. NEJM 2000;343:1064-1069.

Royal Pharmaceutical Society of Great Britain

Mealtime should be an enjoyable experience. Yet, for 12 mil. children with food allergies, eating a meal can be a frightening activity. For some of these children, even the slighagsdhfgdf exposure to the wrong food can be deadly.

Heidi Roehrig is the motherness of a 4-year old boy with nut allergies. A year ago, her son had a severe allergic reaction after eating trail mix with nuts.

“Our life has changed incredibly. Suddenly we’re afraid of play dates and birthdays. These should be fun you want them to be fun for your child but we’re fearful of not being able to control all the foods,” says Roehrig.

In the Roehrig family, simple summer pleasures like going to the ice cream parlor don’t take place anymore. Too many of the ice creams contain nuts, and the family has no way of knowing if surfaces and tools have been cleaned correctly.

“There are lots of things that just aren’t enjoyable anymore because we can’t feel confident that our son isn’t going to have a reaction. Even grocery shopping is a huge ordeal you have to read the label on everything, including foods you buy every week, because you never know when it’s going to change,” she says.

The impact of food allergies on the family is tremendous. For the families of children who have developed severe food allergies, it alters every aspect of life, whether it’s babysitters, daycare, visiting family and friends, even going to the doctor’s office.

The process of diagnosing food allergies, though welcome, also poses its own problems. Testing children with serious food allergies can be an extremely stressful and even dangerous situation. These concerns have prompted the University of Michigan Health System to create an innovative Food Allergy medical institution that offers families a safe and relaxing facility to agsdhfgdf or challenge for food allergies. It was designed specifically to provide a safe environment for hypersensitivity reaction experts to evaluate and treat patients with food allergies.

“We have built a controlled area where children can come to be evaluated and diagnosed. The resulting data allow us to develop what we call a ‘challenge.’ In most of our challenges, we introduce a food that we believe can be tolerated now that the child is older. We can also do airborne challenges to see if a child will have an allergic reaction to a smell, such as to peanuts,” explains Marc McMorris, M.D., medical director of the clinic and clinical associate professor of internal medicine and pediatrics.

Because some food allergies, including the smells, can be dangerous or life-threatening, the clinic’s design controls airflow from room to room, allowing several patients to be seen and evaluated at the same time.

“We also have more control over preparing the foods that is essential when it comes to certain types of foods, or developing challenges where we want to be able to hide the food in certain otherness kinds of food and feed it to the patient without them knowing they’re getting it,” says McMorris.

Allergy facts

An allergen is any substance that causes an allergic reaction. Having a food hypersensitivity reaction means your body’s immune system mistakenly believes the food is harmful.

Food allergies can be more severe than airborne allergies because the food is ingested and then absorbed throughout the body. Airborne allergies are filtered by the eyes or nose, so they don’t enter the body’s system so completely.

The number of group with food allergies is increasing. Experts believe the number has doubled in the past 10 years. There are about 12 mil. Americans with food allergies, and as many as five to 8 % of children under age 3 have food allergies.

There are several theories about why the number of group with allergies is increasing:

– Experts believe this may be due to the way we process our foods. For example, in the United States, peanuts are dry roasted. This makes the compound found in peanuts that triggers an allergic reaction more easily exposed to the immune system.

– Some experts say American children are so well-protected from infection that the immune system, not needing to work as hard to fight infections, switches its focus to allergens, the foreign substances the body attacks in an allergic reaction.

– Heredity might play a role, too. If your parents are allergic, then you’re more likely to have allergies. If one parent has allergies, as many as 50 % of their children also will have allergies. If both parents have allergies, there’s as much as a 70 to 80 % risk that their children will develop allergies of some sort.

What to watch for

The top high-risk foods in this country are milk, eggs, peanuts, tree nuts, fish, shellfish and, recently, sesame seeds.

Food allergies can be life threatening. Reactions range from a few hives to a mild skin reaction to a life-threatening severe reaction.

University of Michigan Health System
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Ann Arbor, MI 48109-2435
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http://www.med.umich.edu

Patients who have had a heart attack and are treated with a high dose of a statin drug did not have significant reduction in the primary outcome of major cardiac events (coronary death, nonfatal acute heart attack, or cardiac arrest with resuscitation), but did appear to have reduced risk when certain secondary outcomes (composite end points of any coronary heart disease event) were examined, according to a study in the November 16 issue of JAMA. This study is being released early to coincide with its presentation at the American Heart Association’s annual meeting.

Lowering of low-density lipoprotein cholesterol (LDL-C) with statins has in the last decade become part of the standard pharmacotherapy regimen in patients with established coronary heart disease (CHD), according to background information in the article. The most common pharmacotherapy regimen for such patients in northern Europe has been simvastatin, 20 to 40 mg/d. In a recent trial among patients with acute coronary syndromes, incremental benefit was demonstrated with more intensive lowering of LDL-C to well below 100 mg/dL. Another study comparing high and low doses of Atorvastatin in stable nonacute CHD found significant improvement in prognosis with respect to cardiovascular disease. In that study, however, the benefit of reduced cardiovascular death appeared to have been offset by a higher number of deaths due to noncardiovascular causes. Although this difference did not reach statistical significance and could well be due to chance, it led to a call for further safety information on the use of Atorvastatin at a dose of 80 mg/d.

Terje R. Pedersen, M.D., Ph.D., of Ulleval University Hospital, Oslo, Norway and colleagues with the Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) study examined whether intensive lowering of LDL-C with Atorvastatin at the highest recommended dose would be more beneficial compared with the moderate, most widely used dose of simvastatin. The randomized trial was conducted at 190 cardiology care and specialist practice centers in northern Europe between March 1999 and March 2005, with a median (mid-point) follow-up of 4.8 years.

The study included 8,888 patients aged 80 years or younger with a history of acute myocardial infarction (MI; heart attack). Patients were randomly assigned to receive a high dose of Atorvastatin (80 mg/d (n=4,439), or usual-dose simvastatin (20 mg/d; n=4,449).

During pharmacotherapy, mean LDL-C levels were 104 mg/dL in the simvastatin group and 81 mg/dL in the Atorvastatin group. The primary end point of coronary death, acute myocardial infarction, or cardiac arrest with resuscitation occurred in 463 patients (10.4 percent) in the simvastatin group and in 411 (9.3 percent) in the Atorvastatin group and was not statistically significantly different between the two groups. There were 178 coronary deaths (4.0 percent) in the simvastatin group vs. 175 (3.9 percent) in the Atorvastatin group. Nonfatal myocardial infarction occurred in 321 patients (7.2 percent) in the simvastatin group and in 267 (6.0 percent) in the Atorvastatin group.

The composite secondary end point of a major cardiovascular event including stroke was reduced in the Atorvastatin group. Similarly, there were reductions in the risk of nonfatal MI, any CHD event, and any cardiovascular event. The risk of death from any cause was similar in both study groups. There were no significant differences in noncardiovascular deaths between the pharmacotherapy groups. There were no significant differences in the frequency of serious adverse clinical events between the 2 groups. Patients in the Atorvastatin group had higher rates of drug discontinuation due to nonserious adverse events.

“In summary, when comparing standard and intensive LDL-C-lowering therapies in patients with previous myocardial infarction, there was no statistically significant reduction in the primary end point of major coronary events, but there was reduced risk of other composite secondary end points and nonfatal acute MI. There were no differences in cardiovascular and all-cause mortality. The results indicate that patients with myocardial infarction may benefit from intensive lowering of LDL-C without increase in noncardiovascular mortality or other serious adverse reactions,” the authors conclude. (JAMA.2005; 294:2437-2445.)

This study was sponsored by Pfizer Inc. For the financial disclosures of the authors, please see the JAMA article.

Editorial: The IDEAL Cholesterol - Lower is Better

In an accompanying editorial, Christopher P. Cannon, M.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, discusses the results of the study by Pedersen et al.

“What are the messages for patients from the IDEAL and other statin trials? First, for the ‘bad’ cholesterol, LDL-C, lower is better for preventing MI stroke, need for cardiac procedures, and death. Second, statins are safe overall, even for patients with extremely low pharmacotherapy LDL-C levels. However, patients and physicians have to work as partners to monitor for adverse effects, which can occur in up to 5 percent of patients but that only rarely can be life-threatening. Fortunately, these are almost always reversible and do not lead to any permanent damage. Third, patients should know their cholesterol numbers, for both LDL-C and HDL-C, to enable them to see how much lowering is needed to reach targets of an LDL-C level of less than 100 mg/dL for patients with risk factors or less than 70 mg/dL for patients with heart disease.”

“And fourth, any drug pharmacotherapy should be taken together with an appropriate diet and exercise program to lower cholesterol and overall vascular risk. The amount of LDL-C lowering with diet is only in the range of 7 percent to 12 percent. Clearly, diet is a central part of the pharmacotherapy, but to get the benefits of very low cholesterol levels, drug pharmacotherapy is often necessary. Optimal use of diet and appropriate use of medications will dramatically reduce the risk of MI, stroke, and death from heart disease. These new data should help motivate any patients who have been hesitating about treating their cholesterol to talk with their physician to get the benefits of intensive cholesterol lowering.”

“Finally, the scientific community needs to continue to pursue new avenues of pharmacotherapy, with approaches that may well be ‘beyond statins.’ Even with intensive statin therapy, the current best evidence-based pharmacotherapy available, many patients still will have recurrent cardiovascular events. New strategies may include development of new agents to achieve even lower target LDL-C levels, substantially increase HDL-C levels, reduce triglycerides, reduce C-reactive protein and other components of inflammation, and modify many other identified components of vascular disease,” Dr. Cannon writes.

(JAMA.2005; 294:2492-2494.)

For the financial disclosures of Dr. Cannon, please see the JAMA article.

Terje R. Pedersen, M.D., Ph.D.
t.r.pedersen@medisin.uio.no
JAMA and Archives Journals
www.jamamedia.org

Pfizer Inc said today that patients with coronary artery disease who took its blood pressure lowering medicine Norvasc (amlodipine besylate) had 31 percent fewer major cardiovascular events compared to patients who received standard care. The results were published today in the current issue of the Journal of the American Medical Association.

In the two-year Comparison of Amlodipine vs Enalapril to Limit Occurrences of Thrombosis (CAMELOT) trial, 1,997 patients with coronary artery disease and normal or well-controlled hypertension received either Norvasc, the ace-inhibitor enalapril (Vasotec) or placebo to compare the medicines’ effectiveness in reducing major cardiovascular events. Eighty-five percent of the Camelot patients received pharmacotherapy for high cholesterol and 20 percent of these patients had diabetes. Patients also received standard care which included aspirin, beta-blockers, other antihypertensive medications and statins.

Norvasc-treated patients experienced 42 percent fewer hospitalizations for chest pain and 27 percent fewer coronary revascularization procedures, such as angioplasty and coronary artery bypass surgery, compared to patients receiving placebo.

Patients treated with enalapril experienced 15 percent fewer cardiovascular events compared to patients treated with placebo, which was not significant.

Major cardiovascular events included cardiovascular-related death, non-fatal heart attacks or stroke, resuscitated cardiac arrest, coronary revascularization procedures, hospitalization for angina (or chest pain), congestive heart failure or procedures to treat peripheral vascular disease.

“The results of CAMELOT further confirm what has been shown in previous studies-that Norvasc provides cardiovascular benefits to patients with coronary artery disease in addition to effectively and safely reducing blood pressure levels,” said Dr. Joseph Feczko, president of Worldwide Development at Pfizer. “This gives healthcare professionals important information on the best long-term care pharmacotherapy for patients with coronary artery disease. These patients are often taking multiple therapies to treat other serious cardiovascular conditions.”

An intravascular ultrasound (IVUS) sub-study of 274 patients from the CAMELOT trial demonstrated that patients who received Norvasc showed no significant increase in the progression of plaque build-up in coronary arteries. The aim of the IVUS sub-study, The Norvasc for Regression of Manifest Atherosclerotic Lesions by Intravascular Sonographic Evaluation (NORMALISE) was to examine whether these patients would experience a reduction in build-up of plaque in the arteries. Patients receiving placebo showed a significant increase in plaque.

“CAMELOT indicates that the anti-anginal and anti-hypertensive effects of amlodipine (Norvasc) may contribute to the overall reduction in cardiovascular events in patients with coronary artery disease,” said Dr. Peter Libby, M.D., Chief of Cardiovascular Medicine at the Brigham and Women’s Hospital, Boston MA and Harvard Medical School Professor who served on the CAMELOT steering Committee. “In addition, the IVUS sub-study has shown that amlodipine may also slow plaque progression in the coronary arteries of certain patients, which may further contribute to improved clinical outcomes. As the people with coronary artery disease in this study had “normal” blood pressures at the outset, we may need to rethink whether levels of blood pressure we consider normal today are really optimal for this group of patients.”

Researchers in NORMALISE used technology known as intravascular ultrasound, which is a three-dimensional method of imaging, to measure the total plaque volume in a cross-section of the artery wall over the length of the vessel. The total plaque volume of the patients was measured at the beginning and at the conclusion of the study.

Coronary artery disease (CAD) is the development of atherosclerosis in the coronary arteries. CAD is the most common form of cardiovascular disease. Atherosclerosis, which is a leading cause of death from heart attack and stroke, occurs when there is a build-up of cholesterol-rich fatty areas called plaques in the arteries. The break-up and dispersal of these plaques can block the blood flow throughout the body, which can be fatal. It is estimated that atherosclerosis accounts for more than 75 percent of all deaths from cardiovascular disease.

Since its introduction in 1990, Norvasc has become the world’s most-prescribed branded antihypertensive therapy. Norvasc has been studied in over 400,000 patients and has achieved more than 30 billion patient-days of therapy worldwide.

Norvasc is a major component of Caduet (amlodipine besylate/Atorvastatin calcium), the first dual therapy medicine to treat two different conditions-high blood pressure and high cholesterol. Caduet was approved by the (Food and Drug Administration) in February 2004. Norvasc is also being studied in the ongoing Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), which is examining whether the newer classes of antihypertensives are more beneficial in reducing adverse cardiovascular events then older classes. The cholesterol-lowering arm of the study ended nearly two-years earlier than planned, due to the highly significant cardiovascular benefits demonstrated in patients taking Lipitor. In ASCOT, patients with normal or mildly elevated cholesterol levels who took Lipitor had 36 percent fewer fatal coronary events and non-fatal heart attacks than patients treated with placebo. To date, both Norvasc and Lipitor have been shown to reduce the risk of cardiovascular events.

Norvasc is indicated for hypertension and angina. In other clinical trials, the most common side effects for Norvasc versus placebo were edema (8.3% vs 2.4%), headache (7.3% vs 7.8%), fatigue (4.5% vs 2.8%) and dizziness (3.2% vs 3.4%).

Lipitor (Atorvastatin calcium) is a prescription drug used with diet to lower cholesterol. Lipitor is not for everyone, including those with liver disease or possible liver problems, women who are nursing, pregnant, or may become pregnant. Lipitor is not indicated for the prevention of heart disease or heart attacks.

Patients who take Lipitor should tell their doctors about any unusual muscle pain or weakness. This could be a sign of serious side effects. Patients should also inform their doctor about any medications they are currently taking to avoid possible serious drug interactions. Prescribing physicians may do simple blood agsdhfgdfs to monitor liver function before and during drug pharmacotherapy. The most commonly reported side effects are gas, constipation, stomach pain and indigestion. They are usually mild and tend to go away.

Blood flow to the parts of the brain that support memory function differs between people with high blood pressure and those with normal blood pressure, and this difference seems to increase when high blood pressure is treated with medications, researchers reported at the American Heart Association’s 61st Annual Fall Conference of the Council for High Blood Pressure Research.

“It does not mean that those with high blood pressure were remembering significantly less; rather, the brain areas acting together during memory required more blood flow to remember the same things as people who did not have high blood pressure in the study,” said lead author J. Richard Jennings, Ph.D.

In a previous study, Jennings and colleagues found that people with hypertension differed from those without hypertension in the amount of brain tissue activated during memory tasks.

“In this study we wanted to find out if treating people for high blood pressure would change that pattern of activation,” said Jennings, a professor of psychiatry and psychology at the University of Pittsburgh School of Medicine in Pittsburgh, Pa.

The researchers assessed the brain blood flow of 28 adults with untreated hypertension while they were doing a memory task. The researchers then randomly divided the subjects into two hypertension pharmacotherapy groups. Half received the angiotension-converting enzyme inhibitor lisinopril; the other half received the beta-blocker atenolol. Subjects took the medication for a year before researchers agsdhfgdfed them in the same way, again monitoring their blood flow to the brain as they did the memory task.

Jennings and colleagues were surprised to find that taking either antihypertensive medication actually increased the inefficiency of the brain’s work during memory. He explained that, when doing memory tasks, four areas of the brain become active in different ways: the thalamus, posterior parietal, prefrontal area and hippocampus.

“In the first study, we looked at the correlation between the activation of those areas. We wanted to see if the areas tend to be activated in a correlated way; so, if you had a lot of activation in the prefrontal area, did you also have a lot of activation in the parietal area”" he said. “When we asked that question in our first study, we found out that the correlation in those areas was higher in people with high blood pressure than it was in people who didn’t have high blood pressure. That means that more brain tissue was getting coordinated during the memory task in people with high blood pressure than in those with normal blood pressure.

“After a year of pharmacotherapy for their high blood pressure, we expected that we’d find that the correlation between those areas actually would decrease; so, the patients treated with hypertensive medication would look more like those with normal blood pressure. Instead, the correlation actually increased. After pharmacotherapy the hypertensive patients were activating even more blood flow to those areas at the same time,” Jennings said.

According to Jennings, the coordination between brain areas doing the memory task was more than twice as much in the hypertensive patients after pharmacotherapy as compared to before pharmacotherapy — and this difference was even bigger compared to people without hypertension.

“Further research is needed to find out what this means to memory function, and whether having hypertension and taking antihypertensives might have the unanticipated effects of changing brain function and causing mental fatigue,” he said.

“This research is reassuring to those concerned about hypertension therapy’s adverse effects, particularly cognitive effects. Treating hypertension is not only beneficial for extending life, but also for improving the quality of life,” said Daniel W. Jones, M.D., American Heart Association President, Vice Chancellor for Health Affairs, Dean, School of Medicine, and Herbert G. Langford Professor of Medicine, University of Mississippi Medical Center.

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Co-authors are Matthew Muldoon, M.D.; Israel Christie, Ph.D.; Julie Price, Ph.D. and Carolyn Meltzer, M.D. The study was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health.

Statements and conclusions of abstract authors that are presented at American Heart Association/American Stroke Association scientific meetings are solely those of the abstract authors and do not necessarily reflect association policy or position. The associations make no representation or warranty as to their accuracy or reliability.

Contact: Karen Astle
American Heart Association

Balance tends to erode with age, which can lead to falls. For older people, falls are the leading cause of death from injury and a major cause of disability. Even if a fall doesn’t cause severe damage, it increases the chances of another fall. Yet falls aren’t an inevitable consequence of growing older. It’s possible to regain equilibrium and compensate for permanent balance deficits, reports the August issue of the Harvard Health Letter.

Conflicting reports from our eyes, ears, and central nervous system can affect our balance. But balance can also suffer from such disorders as these:

– Neurological conditions. Parkinson’s disease, multiple sclerosis, and strokes are among those that can affect balance.

– Diabetes. Nerve damage in the feet makes it difficult to walk.

– Vertigo. This sensation of dizziness may come from ear disorders or simply from the aging of the inner ear’s balance system.

– Postural hypotension. A drop in blood pressure when you sit up or stand up can cause lightheadedness and even fainting.

– Foot problems. Corns, bunions, and hammertoes are both a cause and a result of uneven balance.

– Eye diseases. Cataracts and glaucoma are stealthy thieves of sight and balance. Balance nearly always improves after successful cataract surgery.

– Medications. Sedatives, blood pressure medicines, antidepressants, and antihistamines are among those that may cause dizziness.To retain or regain your balance, the Harvard Health Letter suggests that you get active to maintain the neural connections necessary for good balance, improve your posture so you won’t be apt to fall, and maintain your strength for a good foundation.

Also in this issue:

- Heimlich not always best response to choking
- Benefits of chewing gum
- Viagra may help with Raynaud’s disease
- Watching TV vs. playing video games
- A doctor discusses: An alternative to atenolol, and the laagsdhfgdf on chronic fatigue syndrome

The Harvard Health Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $28 per year.
Harvard Health Letter