Month: December 2013

Fetal stem cell grafts successfully help brittle-bone babies

In an international collaboration, researchers from Sweden, Singapore and Taiwan successfully treated two babies with a congenital bone disease that causes stunted growth and repeated fracturing by injecting them in utero with bone-forming stem cells.

Results of their longitudinal study have been published in the journal Stem Cells Translational Medicine.

Osteogenesis imperfecta (OI) not only stunts the growth of those who suffer from this disease, but the repeated fractures it causes are painful.

However, this condition can be recognized prenatally with an ultrasound, so researchers from the Karolinska Institutet in Sweden published a paper in 2005 detailing how mesenchymal stem cells – connective tissue cells that form and improve bone tissue – were given to a female fetus in Sweden.

These stem cells were taken from the livers of donors, and the researchers note that though the donors and recipients were not genetically matched, there was no rejection.

In this recent study, the team explains how the girl experienced several fractures and had scoliosis by age 8. At this point, the researchers gave her a fresh stem cell graft from the same donor as before.

For the following 2 years, the child did not experience any new fractures and her growth rate improved. Today, the researchers say, she participates in dance lessons and gym class at school.

‘International effort needed’ for this rare disease
The team from Karolinska Institutet, along with colleagues in Singapore, detail how they gave another baby girl from Taiwan – who was shown prenatally to have OI – stem cell transplantation in utero.

The girl experienced a normal, fracture-free rate of growth until she was 1-year-old, at which point the team gave her a fresh stem cell treatment.

Her normal growth resumed, the team says, and now, at the age of 4, she is able to walk normally and has not experienced any new fractures.

“We believe that the stem cells have helped to relieve the disease since none of the children broke bones for a period following the grafts, and both increased their growth rate,” says study leader Dr. Cecilia Götherström, from Karolinska Institutet.

She adds:

“Today, the children are doing much better than if the transplantations had not been given. OI is a very rare disease and lacks effective treatment, and a combined international effort is needed to examine whether stem cell grafts can alleviate the disease.”
The team says they identified a male patient from Canada who was born with OI, which was caused by the exact same mutation that the girl from Sweden had.

Born with severe widespread bone damage, this boy was not given stem cell therapy like the girls were, and he experienced numerous fractures and kyphosis of the thoracic vertebrae – a condition that causes an extreme curvature of the spine, impairing breathing.

The untreated boy died within his first 5 months from pneumonia, the investigators say.

Although the researchers say their findings suggest the stem cell therapy treatment “appears safe and is of likely clinical benefit,” they add that “the limited experience to date means that it is not possible to be conclusive and that further studies are required.”

When asked what kind of research she and her team are planning for the future, Dr. Götherström told Medical News Today:

“We are presently transplanting stem cells to one patient once a year for 4 years to investigate the effects of repeated infusions.

Also, we wish to include more patients with severe OI to be transplanted in the future, which will require joint international efforts and financial resources.”

The study was funded by a grant from the Swedish Society for Medical Research.

Neuroscientists Print ‘Cells from The Eye’ Using An Inkjet Printer

An inkjet printer was used by neuroscientists to print cells from the eye. This forms a practical step in the quest to grow replenishment tissue for damaged or diseased organs.

Researchers at England’s University of Cambridge extracted two types of cells from rat retinas and sent them through a printer nozzle to see if they survived.

The cells remained healthy after being “printed,” retaining their ability to survive and grow in culture, they reported in the British journal Biofabrication.

Three-dimensional printing is one of the new frontiers in engineering.

In that field, liquid or powdered polymers are substituted for ink. Sprayed in layers, the plastic forms a 3-D shape — a boon for designers or exporters, for example, who want to show off a model of their product.

But biotechnologists are also interested in printing, given the potential it offers for building artificial tissue in layers.

This is the first time that the technology has been used to successfully print mature cells from the central nervous system, the scientists said. They cautioned, however, that much work lay ahead.

The co-authors, Keith Martin and Barbara Lorber of the university’s John van Geest Centre for Brain Repair, said the hope was one day to build retinal tissue for people suffering from degenerative diseases of the eye.

“The loss of nerve cells in the retina is a feature of many blinding eye diseases,” they said in a press release.

“The retina is an exquisitely organised structure, where the precise arrangement of cells in relation to one another is critical for effective visual function.”

The team used a piezoelectric inkjet printer head, which expelled so-called glia cells and retinal ganglion cells from adult lab rats through a single nozzle less than one millimetre (0.04 of an inch) across.

The feat is important, because inkjet fluid has a narrow margin of error in terms of viscosity and surface tension. Adding cells to the liquid “complicates its properties significantly,” said inkjet engineer Wen-Kai Hsiao.

The only hitch was a large loss in the number of cells through sedimentation, meaning that they tended to sink to the bottom of the fluid reservoir and could not be printed.

But the cells that were printed were undamaged and sound. The delicate cellular membranes survived, despite the high speed at which they were ejected.

The next steps will be to see if other retinal cells, including light-sensitive photoreceptors, can be successfully printed and experiment with commercial print heads, which use multiple nozzles.

Source: Med India

Death penalty in the United States gradually declining

A shortage of lethal injection chemicals has contributed to declining use of capital punishment in the United States with a new report on Thursday noting only 39 executions this year.

It is only the second time in the past two decades the annual number of inmates put to death has dropped below 40.
The total represents a 10 percent reduction from last year. No further executions are scheduled in 2013.

Un-tested drugs used in executions

“Twenty years ago, use of the death penalty was increasing. Now it is declining by almost every measure,” said Richard Dieter, executive director of the Death Penalty Information Center, and the author of the report.

“The recurrent problems of the death penalty have made its application rare, isolated, and often delayed for decades. More states will likely reconsider the wisdom of retaining this expensive and ineffectual practice.”

The nonprofit organization provides accurate figures and a range of analysis, but opposes use of the death penalty.
Lethal injection in nine states

While the annual number of executions and death sentences continues to drop nationally overall, it remains a legally and socially acceptable form of justice for aggravated murder in 32 states.

But just nine states conducted lethal injections this year, and two — Texas with 16 and Florida with 7 — accounted for nearly 60 percent of the total.

Texas is among the active death-penalty states scrambling to find new lethal injection protocols after European-based manufacturers banned U.S. prisons from using their drugs in executions.

Among them is Danish-based Lundbeck, which manufactures pentobarbital, the most commonly used — either as a single drug, or in combination with others — to execute prisoners.

New drug combinations

States have been forced to try new drug combinations or go to loosely regulated compounding pharmacies that manufacturer variations of the drugs banned by the larger companies, according to an investigation last month by CNN’s Deborah Feyerick.
A pending lawsuit against Texas filed by several death row inmates and their supporters alleges the state corrections department falsified a prescription for pentobarbital using an alias.

Until recently, most states relied on a three-drug “cocktail,” but many jurisdictions now use a single dose or a two-drug combination.
Various state and federal courts have postponed some planned executions until issues surrounding the new protocols are resolved.
Every execution this year relied on pentobarbital, except in Florida, which used midazolam hydrochloride — a drug applied for the first time in human lethal injections.

And Missouri was prepared to inject a single dose of the anesthetic propofol for its two recent executions, until Gov. Jay Nixon halted its application.

The European Union had threatened to limit export of the widely used drug for other purposes if the state had proceeded. The two inmates were separately put to death in recent weeks using pentobarbital instead.
First woman executed

Among the high-profile capital cases this year involved Kimberly McCarthy, the first woman executed in the United States in three years.

The former Dallas-area resident was convicted of murdering her neighbor, and in June became the state’s 500th prisoner to die at the hands of the government since 1976, when the Supreme Court allowed capital punishment to resume.
So far, 1,359 people have been put to death across the country since that time, using lethal injection, electrocution, gas chamber, hanging, and firing squad. That includes three federal prisoners.

Spared for now was Georgia inmate Warren Hill, whose attorneys say he is mentally disabled. Courts earlier this year stayed three separate execution dates, one with just minutes to spare.
The Supreme Court in March will hold oral arguments and decide whether the Florida scheme for identifying mentally disabled defendants in capital cases violates previous standards established by the high court.
Freddie Lee Hall and an accomplice were convicted of the 1978 murders of a pregnant 21-year-old woman and a sheriff’s deputy in separate store robberies, both on the same day. His lawyers say the death row inmate has an IQ of 60.
In Missouri, Reginald Griffin was freed in October and his sentence thrown out after the state high court found the trial prosecution withheld critical evidence that may have implicated another prisoner in a jailhouse murder.
He became the 143rd person exonerated from death row in the past 40 years.

Maryland abolishes death penalty

Maryland became the sixth state in as many years to abolish its death penalty, joining Connecticut, Illinois, New York, New Jersey, and New Mexico. Eighteen other states have previously done so.
Attorney General Eric Holder faces a tough decision in coming months: whether to seek the death penalty in federal court for Boston Marathon bombing suspect Dzokhar Tsarnaev.

Across the country, capital sentences remain at historic lows, with just 79 so far this year.
They have declined in number by 75 percent from 1996, said the report, when 315 people were put on death row.
With the death penalty declining and recent polls showing a corresponding drop in public support, some legal analysts wonder if the Supreme Court is prepared in coming years to take another look at the issue’s overall constitutionality — whether capital punishment in the 21st century represents “cruel and unusual punishment.”

No sign of Supreme Court review
The justices in most cases continue to deny most requests for stays of executions, usually without any comment, or a breakdown of which members of the nine-member bench might have granted such a delay.
“It certainly seems that it merits another day in court after 40 years,” said Evan Mandery, a law professor at John Jay College of Criminal Justice, and author of the new book “A Wild Justice: The Death and Resurrection of Capital Punishment in America.”

“There are a lot of reasons to think that (moderate-conservative) Justice Anthony Kennedy’s vote is up for grabs and his mind is open on this question. So I don’t think the outcome of a case would be predetermined one way or another.”

But there is no sign such a monumental legal and social review by the nation’s highest court will be coming soon.

Source; CNN

Ancient hand bone dates origins of human dexterity

The discovery of an ancient bone at a burial site in Kenya puts the origin of human hand dexterity more than half a million years earlier than previously thought.

In all ways, the bone – a well-preserved metacarpal that connects to the middle finger – resembles that of modern man, PNAS journal reports.

It is the earliest fossilised evidence of when humans developed a strong enough grip to start using tools.

Apes lack the same anatomical features.

The 1.42 million-year-old metacarpal from an ancient hominin displays a styloid process, a distinctively human morphological feature associated with enhanced hand function.

Its discovery provides evidence for the evolution of the modern human hand more than 600,000 years earlier than previously documented and probably in the times of the genus Homo erectussensu lato.

The styloid process helps the hand bone lock into the wrist bones, allowing for greater amounts of pressure to be applied to the wrist and hand from a grasping thumb and fingers.

bones
The styloid process can be clearly seen in the Kaitio bone
Prof Carol Ward and her colleagues note that a lack of the styloid process created challenges for apes and earlier humans when they attempted to make and use tools.

This lack of a styloid process may have increased the chances of having arthritis earlier.

Prof Ward, professor of pathology and anatomical sciences at the University of Missouri, Columbia, said: “The styloid process reflects an increased dexterity that allowed early human species to use powerful yet precise grips when manipulating objects.

“This was something that their predecessors couldn’t do as well due to the lack of this styloid process and its associated anatomy.

“With this discovery, we are closing the gap on the evolutionary history of the human hand. This may not be the first appearance of the modern human hand, but we believe that it is close to the origin, given that we do not see this anatomy in any human fossils older than 1.8 million years.

“Our specialised, dexterous hands have been with us for most of the evolutionary history of our genus, Homo. They are – and have been for almost 1.5 million years – fundamental to our survival,” she said.

The bone was found at the Kaitio site in West Turkana, near an area where the earliest Acheulian tools have appeared. Acheulian tools are ancient, shaped stone tools that include stone hand axes more than 1.6 million years old.

Israel Tax Authority probes doctors accused of medical tourism corruption

Senior surgeons suspected of taking under-the-table payments from medical tourists. The Israel Tax Authority opened an investigation Tuesday into suspicions that senior doctors are taking under-the-table payments from medical tourists, while the Health Ministry asked the prosecution to consider ordering a police investigation into the issue.

Both moves came in response to a report aired by “Uvda” (Fact), Channel 2 television’s investigative journalism program, Monday night. The report showed three senior surgeons at Tel Aviv’s Ichilov Hospital – Prof. Shlomo Constantini, Prof. Zvi Ram and Dr. Yossi Paz – demanding large sums of money from a journalist posing as an agent for medical tourists. Paz even told the “agent” he would give her a receipt for the payment.

Tuesday morning, tax authority investigators asked the “Uvda” crew for any material that would assist their probe. Later in the day, the investigators went to Ichilov to search for information.

The Tax Authority said it doesn’t comment on investigations. Attorney Navot Tel-Zur, representing Constantini and Ram, said he doesn’t wish to comment at this stage.

The Health Ministry made its request for a criminal investigation in a letter to the brand-new state prosecutor, Shai Nitzan.

“Unfortunately, the [television] report doesn’t leave much room for doubt regarding the nature of the transactions,” wrote the ministry’s legal advisor, Mira Huebner-Harel. “The responses that were quoted, including those of the doctors themselves, don’t alter the picture or remove the burdensome impression that emerges from the investigative report, and the filmed evidence supports this impression to a large extent.”

Huebner-Harel said she wanted maximum coordination between her ministry and the prosecution in investigating the matter “at every appropriate level, including opening a police investigation if you see fit … This coordination is necessary so that the different layers of action don’t clash or disrupt each other.”

“It’s superfluous,” the letter continued, “to point out the great severity with which the health minister and the Health Ministry’s management view this affair, and their determination to do everything necessary to put an end to any manifestation of ‘black-market medicine’ in government hospitals, and in general, and to bring the full force of the law to bear against anyone involved in unacceptable acts of black-market medicine. As noted, we will assist in and get behind any necessary action.”

Health Minister Yael German said the goings-on revealed by the “Uvda” report must be dealt with “at both the personal and the systemic level. On the personal level, everything must be done to put an end to any manifestation of black-market medicine in the health system. Therefore, the Health Ministry’s legal advisor has asked the state prosecutor to examine all necessary modes of action, including opening a police investigation. On the systemic level, the entire issue of medical tourism must be dealt with and regulated, and guidelines to ensure public welfare must be set. This is being done by a public committee that has been considering the problem and studying the issue seriously for several months already. Shocking as the investigative report was, we must ascertain the facts before making decisions.”

On Monday night, shortly after the report was broadcast, Hatzlaha, an organization involved in medical tourism, wrote to Attorney General Yehuda Weinstein, Police Commissioner Yohanan Danino and the tax authority to request that they open a criminal investigation into both the doctors featured in the report and Ichilov’s management. The letter was signed by the organization’s legal advisor, Elad Mann.

The Ometz organization, which promotes good governance, asked State Comptroller Joseph Shapira Tuesday to investigate the entire issue of medical tourism, charging that it “takes up a significant slice of Israel’s public hospitals, and the ones hurt by this are Israeli patients.”

Source: Haaretz

New MCI includes 17 tainted members

People for Better Treatment (PBT), a charitable organization working to establish a better healthcare delivery system in India, has written a memorandum to Health minister Ghulam Nabi Azad pointing out that at least 17 doctors out of the 68 new members nominated or elected to the new Medical Council of India (MCI) were part of the previous MCI which was dissolved in 2010 on ground of rampant corruption.

According to the letter written by PBT president Dr Kunal Saha, in the wake of the serious allegations of pervasive corruption during the era of Dr. Ketan Desai’s former chief of MCI, a new provision (Section 30-A.2g) was added by the legislators in the Indian Medical Council (Amendment) Ordinance 2013 with an aim to prevent anybody from becoming a member of MCI which may destabilize broader interest of the general public. The newly added section states: The central government may remove from office the president, vice-president or any member of the Council who has been found guilty of proved misbehavior or his continuance in office would be detrimental in public interest.

The letter further stated that the presence of these 17 doctors in the next MCI “would undoubtedly undermine public trust on the healthcare regulatory system”. The letter pointed out that “these doctors were part of the previous MCI which was dissolved by your department in 2010 on the ground of wide-spread corruption after then MCI president, Dr. Ketan Desai, was arrested red-handed by the Central Bureau of Investigation (CBI) for taking bribe from a private medical college”. It added that the criminal case against Dr. Desai and others is still continuing in the CBI court in Delhi and elsewhere while Dr. Desai is out on bail.

“These 17 doctors also include Dr. Rani Bhaskaran (nominated from Kerala) who actually proposed the name of Dr. Desai for MCI president in 2009 when her husband, Dr. PC Kesavankutty Nayar, was acting MCI president during Dr. Desai’s re-election in 2009 and a close ally of Dr. Desai, who paved the way for his return and “unopposed” election win to be MCI president on 1st March, 2009,” pointed out the letter.

“It is also pertinent to mention that Dr. Desai was removed from MCI earlier in 2001 at the direction of the Honourable Delhi High Court with scathing criticism that he had turned MCI into a “den of corruption”. “Ironically, Dr. Desai was never found innocent from the specific charges that Hon’ble Delhi High Court labeled against him although he managed to return to MCI in 2009,” it added.

“The sordid saga involving MCI and Dr. Desai over the past many years has greatly damaged public confidence on the medical regulatory system in India. There is little doubt that nomination/election of the 17 doctors, who previously helped Dr. Desai to regain control of the MCI, to become members for the next MCI would further erode public trust in the future of healthcare delivery system,” stated the letter.

The letter urged the health minister to take appropriate steps for immediate removal of the 17 doctor-members from MCI in accordance to Section 30-A.2g of Indian Medical Council (Amendment) Ordinance 2013 for greater public interest and for the ends of justice.
source: Times of India

Maternal Health Program In India Failing To Deliver, Study Shows

A prominent program that claims to reduce infant and maternal deaths in rural India by encouraging mothers to deliver in private hospitals has been unsuccessful, despite the investment of more than $25 million since 2005, a new Duke University study finds.

The Chiranjeevi Yojana program in Gujarat, a state in northwestern India, received the Wall Street Journal Asian Innovation Award in 2006 and has been hailed by some as a model for wide adoption throughout India.

The program was launched in 2006 to help address the shortage of obstetricians at public hospitals accessible to low-income women in rural areas. It aimed to provide free childbirth care at participating private-sector hospitals to women who are below the poverty line. The hospitals are paid 1600 Indian rupees per delivery, approximately $30 to $40. The hospitals may offer additional services to patients and charge separate fees for them. By 2012, approximately 800 private-sector hospitals were participating and the program had helped pay for more than 800,000 deliveries.

Manoj Mohanan, Duke assistant professor of public policy, global health and economics, led the research team. The team surveyed 5,597 households in Gujarat to collect data on births that had occurred between 2005 and 2010. They found no statistically significant change in the probability of delivery in health care institutions, the probability of obstetric complications or the probability that physicians or nurses were present during childbirth.

“We were surprised to find, as well, that even among those who delivered at health care facilities there were no significant reductions in households’ out-of-pocket expenditures for deliveries.”

The findings were published online this week by the peer-reviewed international public health journal, Bulletin of the World Health Organization, in an article titled, “Impact of Chiranjeevi Yojana on institutional deliveries and birth outcomes in Gujarat, India: a difference-in-differences analysis.”

While the study did not determine why patients’ delivery costs did not decline or why the program is ineffective, several explanations are possible, Mohanan said. Media reports in India suggest that despite the promise of free care, hospitals we

re billing women for extra, chargeable services. Providers also complained that the reimbursement amounts were not adequate to cover costs of providing the service.

In addition, mothers may perceive the quality of care at participating private hospitals to be poor, so even when the care is provided for free, demand does not rise. Transportation costs from rural villages also could be a factor, he said.

Mohanan said previous research, which had suggested the program was very successful, had methodological limitations. It did not address the role of self-selection of institutional delivery by pregnant women and did not account for unrelated increases in institutional deliveries that probably occurred as a result of rapid economic growth in the region.

Source: Duke sanford

GMC survey highlights the importance of listening to young doctors

Nearly one in five doctors in training has witnessed someone being bullied in their current post, and more than one in four has experienced undermining behaviour themselves, according to a major survey from the General Medical Council.

In its annual survey of 54,000 doctors in training in the UK the GMC, the independent regulator of the UK’s 250,000 doctors, asks their views on the quality of their training. It is one of the largest surveys of its kind anywhere in the world.

The findings also reveal that more than 2,000 doctors in training (5.2%) had raised a concern about patient safety in 2013 and 13.2 per cent said they had experienced bullying at work.

Niall Dickson, chief executive of the General Medical Council, said:

‘These findings highlight the importance of listening to young doctors working on the front line of clinical care. They support what Robert Francis said – that doctors in training are invaluable eyes and ears for what is happening at the front line of patient care.

“They also suggest that more needs to be done to support these doctors and to build the positive supportive culture that is so essential to patient safety. The best care is always given by professional who are supported and encouraged.

“The survey provides us and employers with crucial information about the quality of the training environment, which is also where patients receive care and treatment. These doctors are in an ideal position to alert us to potential problems and employers will also want to reflect on these results.

“Patient safety remains our top priority and all doctors irrespective of their seniority should feel supported in improving the standards of care for their patients.”

Further analysis of the survey shows that:

• The number of comments on patient safety raised by doctors training in emergency medicine posts have increased since 2012 (from 204 to 287)

• 5,863 respondents had been concerned about patient safety but their concerns had been addressed

• Female trainees and trainees who obtained their primary medical qualification (PMQ) within the UK, are more likely to raise concerns

The findings suggest that hospitals need to engage with doctors in training and use their experiences to help change the culture of their organisations. The survey responses contain examples of good practice showing how organisations which had experienced problems managed them positively and effectively.

According to the GMC, the numbers of concerns raised come from qualitative not quantitative responses. The same issue may also have been raised several times, meaning these numbers will be higher than the actual incidence of the issues.

Source: India Medical times

Fewer teens trying dangerous synthetic marijuana, study shows

Teenagers are smoking less tobacco and drinking less alcohol, but they’re using more marijuana, according to a new report by the National Institute of Drug Abuse.

More than 60 percent of high school seniors do not view marijuana use as harmful and 23 percent report smoking pot in the past month, said the report released Wednesday.

NIDA director Dr. Nora Volkow blames the acceptance and use figures on adults and the media message following marijuana legalization in Colorado and Washington State.

“These changes in perception come because of legalization of marijuana as medicine,” Dr. Volkow said. “Teens use it because they think marijuana is less harmful, since it cannot be as harmful if it has a medical purpose.”

Teen cigarette smoking continues to decline, falling to 10 percent today from 25 percent in 1993, according to the report. Alcohol use peaked in 1997, when 52 percent of high school seniors used alcohol monthly, that is now down to 39 percent.

But experts fear marijuana will continue on the upswing as more states adopt laws allowing medical marijuana, supply grows and prices decline. That is bad news for younger teens who light up.

“When you smoke pot, it interferes with the way you learn and memorize” says Volkow. “If you regularly consume pot, it affects your scholastic achievement.”

In those states where medical marijuana is legal, 34 percent of teens get their pot not from a drug dealer, but someone who buys their marijuana with a prescription. This contradicts the claim by many medical marijuana proponents that state regulations would keep pot out of the hands of kids. In fact, among states reporting the highest teen marijuana use – 19 of the top 20 already legalized medical marijuana.

“We know that for most of those, marijuana is not from prescription given to them but prescription to someone else, whether that is adult relative or friends is not clear,” says Volkow.

But even in states where reefer remains illegal, the DEA says 88 percent of cities report pot is widely available. The agency itself is eradicating 77 percent less pot than just three years ago, suggesting it too is not enforcing pot laws with the same vigor as in decades past.

With less eradication and less enforcement, domestic production is up, forcing the Mexican cartels to ship more of their lesser quality, lower priced pot in bulk to replace revenues lost to domestic competition. Seizures in the Tucson Border Patrol Sector are up 40 percent over last year. Recently, agents seized 10 tons of pot at a checkpoint in Nogales, while on Monday an ultra-light aircraft dumped a large marijuana load just south of Tucson.

Said one agent who asked to remain anonymous, “We are seeing a ton of pot right now.”

Source: recreational flying

Higher blood pressure threshold safe in older adults

Many older adults with high blood pressure can be treated less aggressively, which could mean taking fewer pills to get it under control, according to new treatment guidelines from an expert panel. But not all experts are on board with the advice – including the federal agency that appointed the group.

Panel members stressed that they are not changing the definition of high blood pressure: 140 over 90. For adults aged 60 and older, they are recommending a higher treatment threshold, prescribing medicine only when blood pressure levels reach 150 over 90 or higher.

Too aggressive blood pressure treatment can cause fainting and falls in older patients, or bad interactions with drugs they’re already taking for other illnesses, panel members said.

The panel does endorse the lower target of 140 over 90 for younger adults – and for all adults who also have diabetes or kidney disease.

The guidelines released Wednesday are based on a review of the most rigorous kind of medical research – studies in which patients are randomly prescribed drugs or dummy pills – published since the last update in 2003. The research suggests older patients can avoid major health problems like heart attacks, strokes and kidney disease even when their blood pressure is above the current recommended level, the panel said.

For many patients, two or three drugs – or more – are needed to bring their blood pressure down. Many older adults could probably reduce their doses, or take fewer drugs, to reach the new, less strict target, said Dr. Paul James, a panel member and family medicine specialist-researcher at the University of Iowa.

While the guidelines were updated by a government-appointed panel, they don’t have the government’s endorsement like previous versions. The panel completed its work earlier this year, around the same time that the National Heart, Lung and Blood Institute announced that it was getting out of the guidelines business and turning the job over to the American Heart Association and American College of Cardiology. Updated guidelines from those medical groups are expected in late 2014.

In the meantime, the heart association is raising concerns about the new recommendations, saying that many studies they are based on didn’t last long enough to reveal dangers of undertreated high blood pressure in older patients. The panel also overlooked other evidence suggesting the 2003 government-backed recommendations are sound, said Dr. Elliott Antman, the heart association’s president-elect. He noted that his group last month published a treatment formula that echoes the 2003 advice.

Dr. Gary Gibbons, the federal agency’s director, issued a statement Wednesday emphasizing that his agency has not sanctioned the panel’s report, nor has the broader National Institutes of Health. While noting that the panel decided not to collaborate with the heart groups’ efforts, Gibbons said his agency would work with those groups “to transition” the panel’s evidence review into their update. His statement did not address whether the agency opposes all the panel’s recommendations.

James said panel members chose to release their guidelines independently to get the recommendations out sooner and into the hands of primary care doctors, who treat large numbers of patients with high blood pressure. The guidelines were published online Wednesday in the Journal of the American Medical Association.

Dr. Curtis Rimmerman, a Cleveland Clinic cardiologist, called the guidelines “exceedingly important” given the prevalence of high blood pressure, which affects about 1 in 3 U.S. adults, or 68 million.

Whether many doctors immediately adopt the advice “remains to be seen,” he said. Rimmerman predicted that some will continue to push to get older patients’ blood pressure lower than the new recommendation, especially those with previous strokes or heart problems.

The panel said their guidelines are simply recommendations, and that doctors should make treatment decisions based on patients’ individual circumstances. The experts emphasized that everyone with high blood pressure can benefit from a healthy diet, regular exercise and weight control, which all can help lower blood pressure.

Source; news.nom