Doctors Really Do Raise Your Blood Pressure

WEDNESDAY, March 26, 2014 (HealthDay News) -- Patients' blood pressure readings are notably higher when they're taken by a doctor than by a nurse, a new study finds.

This link between doctors and higher blood pressure readings is known as the "white coat effect," and is believed to be the result of patients being more nervous when examined by a physician.

This effect has been noted in a number of previous studies, but this new paper is the first to confirm it, according to the study authors.

The investigators analyzed data from more than 1,000 people who had blood pressure readings taken by both doctors and nurses during the same visit. The readings taken by doctors were significantly higher than those taken by nurses, the study authors found.

The findings, published in the current issue of the British Journal of General Practice, should lead to changes in the way blood pressure readings are taken, according to lead author Dr. Christopher Clark, of the University of Exeter Medical School, in England.

"Doctors should continue to measure blood pressure as part of the assessment of an ill patient or a routine check-up, but not where clinical decisions on blood pressure treatment depend on the outcome," Clark said in a university news release.

"The difference we noted is enough to tip some patients over the threshold for treatment for high blood pressure, and unnecessary medication can lead to unwanted side-effects," he said.

"Some patients may be erroneously asked to continue to monitor their own blood pressure at home, which can build anxiety. These inappropriate measures could all be avoided by the simple measure of someone other than a doctor taking the blood pressure recording," Clark added.

He suggested that researchers "should also think carefully about how to account for this effect in studies that compare treatment by doctors and nurses. Some studies have concluded that nurses are better at treating [high blood pressure], when in fact those findings could be down to this recording bias."

More information

The U.S. National Heart, Lung, and Blood Institute explains how to prevent high blood pressure.

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Here comes the sun to lower your blood pressure

Jan. 17, 2014 — Exposing skin to sunlight may help to reduce blood pressure and thus cut the risk of heart attack and stroke, a study published in the Journal of Investigative Dermatology suggests.

Research carried out at the Universities of Southampton and Edinburgh shows that sunlight alters levels of the small messenger molecule, nitric oxide (NO) in the skin and blood, reducing blood pressure.

Martin Feelisch, Professor of Experimental Medicine and Integrative Biology at the University of Southampton, comments: "NO along with its breakdown products, known to be abundant in skin, is involved in the regulation of blood pressure. When exposed to sunlight, small amounts of NO are transferred from the skin to the circulation, lowering blood vessel tone; as blood pressure drops, so does the risk of heart attack and stroke."

While limiting sunlight exposure is important to prevent skin cancer, the authors of the study, including Dr Richard Weller of the University of Edinburgh, suggest that minimising exposure may be disadvantageous by increasing the risk of prevalent conditions related to cardiovascular disease.

Cardiovascular disease, often associated with high blood pressure, accounts for 30 per cent of deaths globally each year. Blood pressure and cardiovascular disease are known to vary according to season and latitude, with higher levels observed in winter and in countries further from the equator, where ultraviolet radiation from the sun is lower.

During the study, the skin of 24 healthy individuals was exposed to ultraviolet (UVA) light from tanning lamps for two sessions of 20 minutes each. In one session, the volunteers were exposed to both the UVA rays and the heat of the lamps. In another, the UV rays were blocked so that only the heat of the lamps affected the skin.

The results suggest that UVA exposure dilates blood vessels, significantly lowers blood pressure, and alters NO metabolite levels in the circulation, without changing vitamin D levels. Further experiments indicate that pre-formed stores of NO in the upper skin layers are involved in mediating these effects. The data are consistent with the seasonal variation of blood pressure and cardiovascular risk at temperate latitudes.

Professor Feelisch adds: "These results are significant to the ongoing debate about potential health benefits of sunlight and the role of Vitamin D in this process. It may be an opportune time to reassess the risks and benefits of sunlight for human health and to take a fresh look at current public health advice. Avoiding excess sunlight exposure is critical to prevent skin cancer, but not being exposed to it at all, out of fear or as a result of a certain lifestyle, could increase the risk of cardiovascular disease. Perhaps with the exception of bone health, the effects of oral vitamin D supplementation have been disappointing.

"We believe that NO from the skin is an important, so far overlooked contributor to cardiovascular health. In future studies we intend to test whether the effects hold true in a more chronic setting and identify new nutritional strategies targeted at maximizing the skin's ability to store NO and deliver it to the circulation more efficiently."

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Republicans pressure Boehner on vote to delay, defund Obamacare

By Richard Cowan and David Lawder

WASHINGTON (Reuters) - Republican leaders in the U.S. House of Representatives faced increasing pressure on Tuesday from their restive caucus for a stop-gap government funding plan that defunds or delays "Obamacare" health reforms.

An aide to House Speaker John Boehner denied a report by the conservative National Review magazine that Boehner had decided to allow a vote on a funding measure that avoids a October 1 government shutdown but defunds President Barack Obama's signature health insurance reform law.

House Republicans were set to discuss their options for the funding deadline in a closed-door meeting on Wednesday morning in the Capitol.

"No decisions have been made, or will be made, until House Republican members meet and talk tomorrow," said Michael Steel, a Boehner spokesman.

After House conservatives rejected a plan put forth by Boehner and House Majority Leader Eric Cantor last week as not strong enough, an alternative measure to delay Obamacare reforms for a year coupled to a year's worth of temporary funding has been gaining steam.

However, one House Republican aide thought the measure most likely would provide government funding through mid-December instead of for the full fiscal year that begins on October 1.

On Tuesday, the plan's author, Representative Tom Graves of Georgia, said that some 70 House Republicans had signed on as cosponsors to the measure, a substantial bloc among the 233 House Republicans.

One of Graves' co-sponsors, Representative Steve Southerland of Florida, said the Obamacare delay plan would be discussed prominently in Wednesday's closed-door meeting.

"We want to protect the American people from a bad law and we want to make sure that the government is funded to provide services that the American people deserve and expect," Southerland told reporters. "It's the Republican party that's trying to figure out as hard as we can to do both of those things."

TOUGH FIGHT SEEN

If the House were to include a provision hobbling Obamacare, the Democratic-controlled Senate is expected to strip it out and simply approve the government program funding, sending it back to the House for final approval. Many House Democratic votes could be needed to win passage of the bill in the Republican-controlled House.

Some Republicans said that they also view a fight over the raising the $16.7 trillion federal debt ceiling as a "fallback" position on delaying Obamacare. The U.S. Treasury has said an increase in federal borrowing capacity is needed by mid-October in order to ensure that payment obligations can be met.

"I think the play is on the debt ceiling. That's where I want to attach the full delay of Obamacare for a year," said Representative John Fleming of Louisiana, adding that he believed the Treasury can continue to pay interest on its debt while cutting back other services.

Some Democrats on Tuesday predicted a tough battle over a potential government shutdown on October 1 as they seek to defend Obamacare and restore spending levels sharply reduced by "sequester" automatic spending cuts.

Representative Steny Hoyer, the second-ranking Democrat in the House, said the atmosphere in Congress is worse than it was in 1995-96 when a similar funding impasse closed federal agencies.

"I think we're going to have a fight," Representative Steny Hoyer told reporters, adding that 18 years ago there were significantly more moderate Republicans willing to seek compromises with Democrats and still there were shutdowns.

Now, Hoyer said, Republicans "terrified of the Tea Party," are hurting prospects for a deal on government spending.

House Republicans backed by the smaller-government Tea Party movement want to use the spending bill and upcoming legislation to raise U.S. borrowing authority as battlegrounds for both paring back the size of government and stopping or delaying a new national healthcare law.

Unless the Republican-controlled House, the Democratic-controlled Senate and Obama reach an agreement on funding levels for Congress in the fiscal year starting October 1, most government activities will grind to a halt for lack of money.

While Senate Democrats are certain to reject any House passed measure to defund or delay Obamacare, which aims to extend healthcare coverage to millions more Americans, taking that step could help revive long-dormant bipartisan negotiations on a broader fiscal solution.

Senate Majority Leader Harry Reid did not offer any help to House Republicans in their dilemma on Tuesday, saying the Senate would simply wait and see what the House passes.

"It's up to the House. We're waiting for them to act. Until they act, we're going to do nothing," said Reid, the Senate's top Democrat.

Hoyer laid down a tough marker, however, saying that he would vote against a stopgap spending bill - even one without attacks on Obamacare - if that measure aimed to spend only $988 billion for the full fiscal year.

"$1.058 trillion I think is the right number," Hoyer said, explaining that it would fund government at the levels called for in a 2011 budget law, but without the additional across-the-board spending cuts that began earlier this year.

Many Republicans want to maintain the tougher deficit-reduction discipline that the automatic spending cuts provide and they argue that Obamacare, over the long-run, will hurt the economy and add to budget deficits.

(Additional reporting By Rachelle Younglai, Editing by Tim Dobbyn and Cynthia Osterman)

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Doctors sometimes over-treat blood pressure: study

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NEW YORK (Reuters Health) - A new study suggests veterans hospitals are following guidelines when it comes to treating patients with diabetes and high blood pressure -- but some diabetics with healthy readings may also be getting intensive blood pressure treatment that won't do them much good.

"Good control of blood pressure is important for decreasing bad outcomes for patients (with diabetes), such as heart attacks and kidney disease," said Dr. Eve Kerr, the study's lead author from the Department of Veterans Affairs Ann Arbor Healthcare System and the University of Michigan.

Doctors have gotten very good at making sure everyone at risk gets treated with blood pressure medications, she added. But some patients who needed blood pressure medications to begin with might end up not needing them later on.

"Sometimes when blood pressure gets too low, it's okay to back off," Kerr told Reuters Health.

Her team examined the medical records of close to one million diabetes patients treated at VA medical centers and outpatient clinics.

The vast majority of patients age 18 to 75 -- 94 percent -- either had normal blood pressure or were getting high blood pressure treated according to guidelines.

That means most diabetic veterans are getting the help they need when it comes to high blood pressure monitoring and treatment. But although under-treating blood pressure may not have been a big problem in the VA group, over-treatment seemed to be at least as common, if not more so, the researchers found.

More than one-third of patients treated at the VA with a blood pressure below 130/65 mm Hg were on at least three blood pressure lowering drugs, or were having their drug regimen increased. That was equal to eight percent of all diabetic veterans.

High blood pressure is considered to be 140/90 mm Hg or higher, according to the National Institutes of Health.

Depending on the hospital, between three and 20 percent of diabetic veterans were possibly being over-treated with blood pressure medications, Kerr and her colleagues reported Monday in the Archives of Internal Medicine.

Not only might those drugs be unnecessary, but they could cause problems for patients as well, researchers said.

"You don't want to put patients on medications unnecessarily, because there's risks with any medication -- whether it's a nuisance risk of a dry mouth or it could be potentially more serious, like making your blood pressure too low and having you more at risk for falls," said Eileen Handberg, a cardiology researcher from the University of Florida in Gainesville.

"You don't want to treat someone's blood pressure to the point that they're weak and dizzy because their blood pressure is too low," Handberg, who wrote a commentary published with the study, told Reuters Health.

She said guidelines don't currently set a lower limit for recommended blood pressure in diabetic patients -- and because of that, it's hard to say doctors in this study were doing anything wrong when they prescribed more blood pressure lowering drugs to people who might not have needed them.

Still, Handberg added, "There is a lot of conversation about, maybe lower isn't always better."

One limitation of the new study is that it can't show whether patients were actually harmed by their blood pressure getting too low, said Dr. Franz Messerli, director of the high blood pressure program at St. Luke's-Roosevelt Hospital in New York.

"We don't know whether over-treatment or under-treatment increased heart attack, stroke or death, and that's obviously the important issue," Messerli, who wasn't involved in the research, told Reuters Health.

Kerr said the new study can help inform future guideline-makers about how diabetic patients are currently being treated -- and how often too much blood pressure treatment might be a concern.

Researchers agreed that patients who find their blood pressure numbers dropping very low or who have side effects such as dizziness should talk with their doctors about their blood pressure and the possibility they can ease off aggressive treatment.

SOURCE: http://bit.ly/LPkvZ8 Archives of Internal Medicine, online May 28, 2012.