Ambulatory Blood Pressure Monitoring Proposed As Gold Standard

Bllod Pressure - OmronThe US Preventive Services Task Force (USPSTF) recommended that physicians use ambulatory blood pressure monitoring to confirm the existence of hypertension in newly suspected cases before instituting therapy. The USPTF has been making recommendations on appropriate health screening for years now. Their new positions now says that patients 40 years of age or older with an initial BP of 130/85 or higher should be screened for hypertension annually instead of every 3-5 years as previously suggested. The recommendation includes annual blood pressure screening for all adult African Americans. Included in the recommendation is a call for the use of ambulatory blood pressure monitoring. It is felt that blood pressure readings in the doctor’s office may be influenced and higher due to anxiety or “white coat hypertension.” Ambulatory Blood Pressure Monitoring providing multiple readings will give you a true average systolic and diastolic reading which permits you to separate hypertensive patients requiring treatment from anxious individuals.

When evaluating a patient for hypertension we have used the 24 hour ambulatory monitor in my office practice for years. It is a traditional blood pressure cuff designed to inflate six times an hour during daytime hours and four times per hour when you go to bed. Patients are asked to shower or bathe prior to coming to the office and to limit their activities to their normal activities of daily living. The patient drops the device off 24 hours later and we connect it to our computer and print out the readings. The device produces hourly readings plus average readings. The major side effects are the inconvenience of wearing a device which inflates six times per hour. Cost has been a factor since most insurance companies have not seen the wisdom of paying for this. In my experience it allows us to classify someone as normal or normotensive and not institute treatment most of the time. Without this type of device we were dependent on looking for complications of hypertension such as changes in the arteries and veins in the eyes using the ophthalmoscope or changes on your EKG to confirm the diagnosis of hypertension. With the development of vital sign monitoring devices associated with cellphones and computer tablets it will only get easier to accurately monitor ambulatory blood pressures in the future. These devices will additionally allow us to check on whether or not our treatment is actually keeping your BP within the limits it should.

We have one monitor in the office at the current time and ask that you make an appointment to have it placed on you if you wish to be checked.

New Hope to Keep the Weight Off

Diet DrugsAs we head into the New Year, with our “new” resolutions, those of us inclined to gain weight are always looking for something new to help us along the way. Announcements regarding new weight loss products or services offer us hope which, in turn, encourages discipline and determination. Along those lines, Gary Frost PhD, of Imperial College London, and associates reported in GUT magazine that their newly developed short chain fatty acid propionate powder helps satiety and prevents weight gain.

Propionate is normally produced when dietary fiber is digested in the gut. Frost and his researchers produced inulin-propionate ester (IPE) to deliver larger quantities of propionate to the colon than can be obtained by diet alone. They noted that propionate stimulates the release of the appetite suppressing hormone PYY and GLP-1 from colon cells in the test tube. They then randomized 20 participants to a pre-meal dose of their propionate compound or just inulin. They then allowed these participants to eat at a buffet. Those given propionate ate 14 % less than those given inulin alone. They then measured the appetite suppressing hormones in both groups and found them higher in the propionate recipients.

This initial study was followed by a study in which 60 overweight patients were given propionate powder (IPE) to put in their food or inulin powder for 24 weeks. Over that time the propionate group had no patient with more than a 5% body weight gain compared to 17% in the inulin group. They then measured abdominal and liver fat and found that the propionate group had far less.

These are initial works with the authors seeing the potential of adding propionate powder to fattening foods. More research is needed but hope springs eternal.

Sarcopenia – A New Issue in Aging

Muscle MassSarcopenia is the medical term for low muscle mass. It affects at least 50% of older adults, however most individuals are unfamiliar with the term. For years doctors themselves did not agree that there was such a problem and there was further disagreement on the definition of what constituted low muscle mass. S. Studenski, MD, Director of Longitudinal Studies Section at the National Institute on Aging says “Sarcopenia is not in anyone’s consciousness as a health problem, although we see it around us all the time. Perhaps we just take it for granted that when you get older you shrink. It doesn’t have to be a normal part of aging. Physicians are now a bit more cognizant of recognizing the condition, treating it and possibly preventing it.”

In a series of articles published in the Journal of Gerontology, May 2014, Dr. Studenski defines the criteria for Sarcopenia based on measurement of diminished hand grip strength and reduced muscle mass. The tests must be performed with specific equipment by professionals in order to meet the criteria for the diagnosis. Patients with Sarcopenia have their youthful muscles replaced by ineffective fat even though their actual body weight may not change.

The consequences of low muscle mass can include issues with mobility, frailty, osteoporosis, falls, fractures, diminished activity, and weight gain and glucose metabolism abnormalities. Dr. Studenski’s studies inclusion criteria are based on observing 26,000 subjects and measuring grip strength and muscle mass in the arms and legs. Diet appears to play a major role in maintaining adequate muscles mass with normal Vitamin D intake of 600 IU per day in ages 51 – 70 and 800 IU in patients over 71 being necessary to retain muscle mass. You need an adequate intake of protein in the 40 – 70 gram range daily. When looking at choice of foods, acid producing foods and foods low in Vitamin B12 and Folic acid can be detrimental. Alkaline foods such as fruits, vegetables, tofu, almonds, herbs and spices are felt to be beneficial. If your diet is adequate and appropriate then exercise, especially modest resistance training exercise, is very beneficial to maintain and rebuild muscle mass.

It appears that testing for hand grip strength and muscle mass will become a standard part of the geriatric evaluation in the future. The recommendations to preserve muscle mass are actually not new. Suggesting we eat a healthy diet rich in fruits, nuts and vegetables and high quality proteins while staying active is nothing new. What is new is the definition and categorization of another benchmark of healthy aging and suggestions on how to maintain it.