Journals Watch - Alcohol, mobile use and hypertension

Short of time to catch up on the journals? Dr Louise Newson guides you through the latest research.

RISKS OF TOO MUCH ALCOHOL

Am J Physiol Heart Circ Physiol 2008; 294: H605-12

Many of us are convinced that a regular alcoholic drink is important to protect our cardiovascular systems. The results of this study will therefore come as a disappointment to some.

This Canadian study has shown that although one alcoholic drink results in vasodilation and reduces cardiac output, a second cancels out these beneficial effects, increasing the heart rate, cardiac output and sympathetic nervous activity.

Findings point to a slight beneficial effect of one drink on the heart and blood vessels, whereas two or more drinks would seem to turn on systems that stress the circulation.

If these actions are repeated frequently because of high alcohol consumption these effects may expose individuals to a higher risk of heart attacks, stroke or chronic hypertension.

But it does still seem to be beneficial to health to have one alcoholic drink on a regular basis.

WOMEN AND HEART FAILURE

Heart 2008; 94: e10

Women with heart failure are less likely to undergo assessment of left ventricular (LV) function and be treated with evidence-based drugs than their male counterparts, European investigators have discovered.

Although there have been major advances in the diagnosis and treatment of heart failure in recent decades, the absolute number of women dying each year is still increasing.

To examine gender differences in clinical characteristics, treatment and outcomes among heart failure patients, this Dutch study looked at 8,914 patients, 47 per cent of whom were women, who had a confirmed heart failure diagnosis, from the Euro Heart Survey on heart failure.

The researchers found that women were less likely to undergo LV function investigation than men, at 59 per cent versus 74 per cent.

Female heart failure patients were also less likely than male patients to be given ACE inhibitors and beta-blockers. There is no evidence-based explanation for this difference.

We need to be more aware of our female heart failure patients potentially being discharged on inadequate medication.

COMPLIANCE TO ANTIHYPERTENSIVES

Arch Intern Med 2008; 168: 271-6

It has been estimated from previous studies that hypertension is still inadequately controlled and targets are still not being reached for many hypertensive patients.

This US study found that patients whose BP was not controlled were more likely to be non-adherent to their medication - meaning that they were taking their medication less than 80 per cent of the time.

Although it was shown that patients with hypertension had their BP medication increased this still did not lead to a reduction in BP - again due to poor patient compliance with medication.

It may be worthwhile questioning our poorly controlled hypertensive patients more closely about their compliance.

DAILY TADALAFIL FOR ERECTILE DYSFUNCTION

Diabet Med 2008; 25: 138-46

It is well-known and accepted that men with diabetes have a greater risk of erectile dysfunction (ED). I think it is surprising that so few of our diabetic patients request any treatment for ED, which is obviously freely available to them.

This double-blinded study involved diabetic men taking the PDE-5 inhibitor tadalafil daily at two different dosages compared with placebo.

The results showed that taking either dosage of tadalafil regularly led to statistically significant improvements in mean success rates for vaginal penetration, completion of intercourse and overall treatment satisfaction.

This was at the cost of a greater incidence of headache, back pain and dyspepsia.

It may be that a once daily PDE-5 inhibitor with their statin, aspirin, ACE inhibitor and diabetic medication is the way forward for the management of erectile dysfunction in patients with diabetes.

MOBILE PHONE TUMOUR RISK

Am J Epidemiol 2008; 167: 457-67

Many people are increasingly concerned about the possible health risks associated with use of mobile telephones.

This research involved studying cases of parotid tumours, both benign and malignant, and assessing the association between cellular phone use and their development.

The results showed that the risk of parotid gland tumours was greatest in those who used the phone on one side only without a hands-free device (odds ratio 1.58) and also for those who used their phones more frequently.

Clearly more work needs to be done in this area.

Dr Newson is a GP in the West Midlands and a member of our team of who regularly review the journals

THE QUICK STUDY

  • Alcohol appears to be beneficial when taken as one drink on a regular basis, but a second drink negates the beneficial effects and can stress the cardiovascular system.
  • Heart failure in women is less likely than in men to be treated optimally.
  • Hypertension medication may be poorly adhered to and compliance should be considered when considering patients who are poorly controlled.
  • Erectile dysfunction in patients with diabetes may be more effectively managed with a PDE5 inhibitor daily rather than as required.
  • Mobile phone use may increase the risk of parotid gland tumours.

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