(Question)
And once again, high blood pressure is making headlines in the news: the American Heart Association and the American College of Cardiology (AHA/ACC) have just released new guidelines about hypertension. Since this development is likely to cause confusion and concern for many, I'm writing this post to help you understand the debate and what this might mean for you and your family. By the way, if you've read any of my other blood pressure articles on this site, let me reassure you: I am not changing my clinical practice or what I recommend to others, based on the new AHA/ACC guidelines. The core principles of better blood pressure management for older adults remain the same: * Take care in how you and your doctors measure blood pressure (more on that here), * Start by aiming to get blood pressure less than 150/90 mm Hg, as recommended by these expert guidelines issued in 2017 and in 2014, * And then learn more about what are the likely benefits versus risks of aiming for more intensive BP control. Perhaps the most important thing to understand is this: treatment of high blood pressure in older adults offers "diminishing returns" as we treat BP to get lower and lower. Scientific evidence indicates that the greatest health benefit, when it comes to reducing the risk of strokes and heart attacks, is in getting systolic blood pressure from high (i.e. 160-180) down to moderate (140-150). From there, the famous SPRINT study, published in 2015, did show a further reduction in cardiovascular risk, when participants were treated to a lower systolic BP, such as a target of 120. However, this was in a carefully selected group of participants, it required taking three blood pressure medications on average, and the reduction in risk was small. As I note in my article explaining SPRINT Senior, in participants aged 75 or older, pushing to that lower goal was associated with an estimated 1-in-27 chance of avoiding a cardiovascular event. (The benefit was even smaller in adults aged 50-75.) What issue did the author have with the AHA/ACC guidelines? A. the scientific evidence B. the cardiovascular risk C. the confusion and concern people are experiencing D. not enough information
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C

(Question)
Some years ago a woman on our staff came into my office to, basically, tell me off and complain to me about others and about myself. This woman had not been very supportive of me in my role ever since I began working there. I couldn't figure out if she was arrogant or lacking in self esteem. During this meeting / confrontation, she told me, in no uncertain terms, just what she didn't like about some recent decisions I had made. I listened to her speak for about 30 minutes. She, quite methodically, tore me apart. Initially, I had planned to hear her out, make a few vague remarks, and send her on her way, thinking that maybe she just needed to be heard. But about 20 minutes into her harangue, I had a change of heart. I decided that, if she asked for a response for me, if she asked my advice, I was going to tell her exactly what I thought. She did, in fact, ask me for a response. I asked her if she was a happy person, and said that I suspected that she was not, as she came across as a bully and was acting like a horrible person. She sat and looked at me, then burst into tears. I waited. Looking up, she said, "Yes, you are correct. I am a horrible person. And I am miserable. What can I do?" We spent some time discussing what she could do, and (even though I didn't want to take the time to do it) I asked her if she would like a mentor me? She said that she would like such a thing. This woman and I ended up becoming fairly, no, very good friends and she has been one of my strongest supporters. I didn't expect that. Why was the woman so upset A. not enough information B. She was miserable at herself C. She was mad at friends D. She was mad at me
(Answer)
B

(Question)
Dietary supplements are big business, with around half of the Australian population using at least one type per year; most commonly a multivitamin and mineral pill. Many people take supplements as a form of dietary insurance in case they are not meeting their nutrient needs from foods alone. Others take them as a form of health insurance to protect against certain diseases. Some just take them out of habit. Supplements do have a role to play in some situations. People with a diagnosed deficiency, those with malabsorption conditions, women planning pregnancy, and people with very poor diets all can benefit from specific nutrient supplementation. But what about the benefit of supplements across the broad population? The mantra of most health professionals, which is even etched on the label of many supplements, is that supplements may only be of assistance if dietary sources are lacking. To see if this is supported by solid evidence, a systematic review of 63 clinical trials involving some form of supplementation in non-pregnant adults was carried out by a team of medical researchers. The clinical trials were broad in their nature with many nutrients studied including vitamins A, B6, B12, C, D and E; folic acid; calcium; selenium, omega-3 fatty acids; ginkgo biloba; glucosamine; saw palmetto; and milk thistle. All of the studies were randomised controlled trials and evaluated a range of health outcomes including risk of heart disease, cancer, diabetes, bone fractures, cognitive function and all-cause mortality. From the 63 studies, no benefit was seen in 45 studies with 10 of these showing a trend towards harm and just two showing a trend towards a benefit. Of the remaining studies, four showed harm with a greater risk of cancer with beta-carotene and a higher risk of fractures with a once-yearly dose of vitamin D. One study showed a lower risk of cancer with selenium supplementation, but this was not validated in much larger trials. Twelve studies showed a benefit and these mostly involved vitamin D... What is probably true about supplements? A. They are taken with conditions B. not enough information C. The aid diseases in the body D. They enrich the body
(Answer)
D