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Medscape
a day ago
- Health
- Medscape
How Much Does Maintaining BP During Surgery Matter?
Efforts to avoid either high or low blood pressure during noncardiac surgery do not appear to make a difference in the cognitive outcomes of patients after the procedures, a new study found. More than 300 million adults worldwide undergo noncardiac surgery each year, and most are taking medications to control their blood pressure, said Maura Marcucci, MD, a specialist in perioperative medicine at McMaster University in Hamilton, Ontario, Canada, and lead author of the study, which her group published last month in Annals of Internal Medicine . 'Blood pressure abnormalities are common during and after noncardiac surgery, and observational evidence have suggested that they are related to possible organ damage, including brain insult, especially in older patients and those whose mechanisms of brain protection might be affected by chronic vascular disease,' Marcucci said. 'On a daily basis, physicians taking care of these patients are confronted with questions around what blood pressure to target intraoperatively and what to do with the patient's blood pressure medications, with the assumption that these choices would affect the patient's risk of complications.' The new study evaluated 2603 surgery patients (mean age, 70 years) with a history of vascular disease or multiple risk factors for vascular events and who were taking antihypertensive medications chronically. The researchers compared outcomes associated with two approaches to regulating blood pressure during the procedures: One aimed to prevent hypotension, the other to avoid hypertension. The primary outcome was delirium in the hospital in the first 3 days after surgery. In the hypotension-avoidance group, patients taking angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or direct renin inhibitors have those medications withheld before surgery and for the first 2 days afterward. For other types of blood pressure medications, decisions on whether to continue or discontinue the drugs were based on the patient's systolic blood pressure following surgery (≥ 130 mm Hg following an algorithm). Anesthesiologists were asked to maintain patients' mean arterial pressure (MAP) ≥ 80 mm Hg throughout surgery. In the hypertension-avoidance group, patients took all of their usual blood pressure medications at the hospital before their operation. The anesthesiologists in these cases were asked to aim to keep MAPs ≥ 60 mm Hg throughout surgery using strategies at their discretion. After surgery, the patients in this group continued taking all of their blood pressure medications as they normally would. All the patients remained on their assigned blood pressure management strategy for 2 days after surgery or until they were discharged from the hospital, whichever came first. In the hypotension-avoidance group, on day 3 after surgery or at discharge, patients were allowed to resume taking all of their blood pressure medications. Marcucci and her colleagues found no difference in neurocognitive outcomes between the two strategies in either the short or the long term. The analysis showed 95 of 1310 patients (7.3%) in the hypotension-avoidance group and 90 of 1293 patients (7%) in the hypertension-avoidance group had delirium (relative risk [RR], 1.04; 95% CI, 0.79-1.38). Of the 701 patients who completed the cognitive assessment at the 1-year mark, 129 of 347 (37.2%) in the hypotension-avoidance group and 117 of 354 (33.1%) in the hypertension-avoidance group had a decline of two or more points on the test (RR, 1.13; 95% CI, 0.92-1.38). By the end of the trial, 19% in the hypotension-avoidance strategy and 27% in the hypertension-avoidance strategy had hypotension requiring some form of intervention (RR, 0.63; 95% CI, 0.52-0.76). Marcucci said the study helps answer two important questions confronting anesthesiologists, cardiologists, and internists: 'It taught us that ensuring that patients' MAP remains above 60 throughout the surgery is safe and that targeting a higher MAP does not make a difference,' she said. 'Also, whether or not patients continued to take all their chronic blood pressure medications throughout the perioperative period did not make any real difference to their blood pressure and heart rate, and hence any difference in patient-centered outcomes.' That the findings held across different subgroups of patients — from young to old, and those on single or multiple drugs for hypertension — 'are reassuring regarding the fact that patients are stable on their chronic medications and that it does not seem that their continuation or discontinuation perioperatively will affect major outcomes, at least not on average. They also leave discretion to physicians to individualize care based on specific situations and following patients' preferences.' In an editorial accompanying the journal article, Idalid Franco, MD, MPH, and Alexander Arriaga, MD, MPH, ScD, of Brigham and Women's Hospital in Boston, wrote the study 'adds to a growing list of publications from high-impact journals, including Annals of Internal Medicine , that have used original research and multidisciplinary guidelines to challenge and update long-standing beliefs about the perioperative management of older adults' and renin-angiotensin-aldosterone system inhibitors (RAASIs). 'At a time when substantial resources are being devoted to improving the quality of perioperative care for an increasingly aging population, Marcucci and colleagues provide us timely and relevant reassurance that the key to improving outcomes may not rely on whether a few doses of RAASIs are held perioperatively or whether intraoperative MAP targets are scripted beyond clinical judgment,' they added.
Daily Mail
19-05-2025
- Health
- Daily Mail
Scientists pinpoint the two diets that could help relieve depression and anxiety
Two simple diet changes could reduce the symptoms of debilitating mental health conditions, a study suggests. A major review by researchers at Bond University in Queensland, Australia, found that calorie restrictive diets may reduce symptoms of depression and anxiety. The research–which included 25 studies involving 57,000 adults–also found that low fat diets may help relieve anxiety. Researchers found that the benefits of a low fat diet on mental health were primarily seen among people at 'elevated cardiometabolic risk'. This included those suffering from conditions like obesity or insulin resistance the latter considered a potential precursor to type 2 diabetes. A calorie restrictive diet is an eating pattern where you limit the amount of calories you consume per day in a bid to lose weight, usually around 1500 calories total. Dieters are also advised to avoid processed foods and products high in sugar. On the other hand, a low fat diet is considered getting less than 30 per cent of your energy intake from fats, a level recommended by the World Health Organisation. Publishing their findings in the journal the Annals of Internal Medicine, the experts said while calorie restrictive and low fat diets may help combat depression and anxiety the quality of the data supporting this was low. As such they recommended any patient suffering from these problems discuss potential dietary changes with a health care professional beforehand. The authors didn't speculate on how diet may help combat mental health issues, but previous studies have established a link between food and mood. In 2017 Australian researchers, published a study in the journal BMC Medicine, where 33 people with major, drug-resistant depression were put on the Mediterranean diet for three months. They were then compared with 34 people with the same condition who continued with their usual diets. The Mediterranean diet group experienced 'significantly greater improvement' in symptoms than the control group. Additionally, last year data from 3,000 adults showed that, after six years, those who followed Mediterranean diet had a 16 per cent lower risk of developing depression than people who didn't. The Mediterranean typically involves focusing on fresh produce, lean meat like fish and chicken, and whole grains, while eating less red meat and sweets. Professor Felice Jacka, an expert in nutritional psychiatry and director of the Food and Mood Centre at Deakin University in Geelong, Australia, previously told MailOnline she is convinced there is link between diet and depression 'Where mental health is concerned, our gut microbes are running us,' said Professor Jacka. She said that a diet rich in unprocessed foods with lots of fruits, vegetables, beans, pulses and grains is the key. Professor Jacka said this fibre-rich diet richly supports a healthy gut microbiome, the population of bacteria, viruses and fungi that naturally live in our digestive tract. Fibre is a type of complex carbohydrate found in plants that our bodies cannot easily break down. This means it passes through the digestive system all the way to the large intestine where it helps feeds trillions of micro-organisms. Fibre's mood benefits have been demonstrated in a review of 18 previous studies, published in the journal Nutritional Neuroscience in 2023. The University of Adelaide researchers found that, for people deemed at risk of depression, each additional 5g of fibre they added to their diet was associated with a 5 per cent reduction of their risk of developing symptoms. The NHS recommends aiming for at least 30g of fibre per day. Experts also warn that a diet in ultra-processed foods (UPFs) can have a negative impact on mental health. Professor Jacka co-authored a study in the journal Clinical Nutrition which concluded that a person's risk of depressive symptoms goes up 10 per cent for each additional 10 per cent that their diet is comprised of UPFs. 'If you do just one thing to improve your mental health through diet, completely cut out soft drinks, ice cream and crisps,' Professor Jacka told MailOnline. While multiple studies have established a link between what we eat and mental health, other experts caution the relationship might not be as clear cut as it seems. They highlight that for UPFs and depression there is no clear cause and effect. Additionally, they note that patients who eat a lot of UPFs are also more likely to be obese, exercise less frequently and more likely to smoke, all of which could influence their mental wellbeing. Mental health charity Mind estimates that one in six Britons are suffering from a common mental health problem like depression and anxiety at any one time. Symptoms of depression range from lasting feelings of unhappiness and hopelessness, to losing interest in the things you used to enjoy and feeling very tearful. Many people with depression also have symptoms of anxiety. There can be physical symptoms too, such as feeling constantly tired, sleeping badly, having no appetite or sex drive, and various aches and pains. For anxiety they say that common symptoms include feeling restless or on edge being irritable, getting tired easily and having tense muscles. The NHS recommended seeing a doctor if you have symptoms of either condition.
Health Line
10-05-2025
- Health
- Health Line
Nuts, Seeds and Healthy Diet May Help Lower Risk of Diverticulitis
New research has found that nuts and seeds do not increase the risk of diverticulitis. The findings confirmed that four key dietary patterns, including the DASH diet, help reduce the risk of diverticulitis onset. The findings were consistent with a similar study previously conducted in males, refuting current recommendations about foods to avoid to prevent diverticulitis. Diverticulitis develops when small pockets in the large intestine become inflamed. It causes uncomfortable digestive symptoms and often requires dietary modifications and restrictions. Now, new research has confirmed that nuts and seeds, previously thought to trigger diverticulitis symptoms, could be back on the menu for people at risk for the gastrointestinal condition. The study examined the effects of females with diverticulitis who followed four dietary patterns known to promote overall health: Dietary Approaches to Stop Hypertension (DASH) diet Healthy Eating Index (HEI) Alternative Healthy Eating Index (aHEI) Alternative Mediterranean diet The participants consumed nuts and seeds, and the researchers also calculated how well they adhered to those four dietary patterns. The results, published on May 6 in Annals of Internal Medicine, showed that females who followed these eating patterns had a reduced risk of diverticulitis. The researchers concluded that nuts and seeds were not associated with an increased risk of the condition. The findings are consistent with a 2008 study that found the same outcomes for males, which could lead to a shift in dietary recommendations for people at risk for the condition. 'We included fresh fruit with edible seeds (raw tomatoes and strawberries) in our analyses because patients still commonly report avoiding these nutritious foods,' the study authors wrote. 'Our findings refute the widely held belief that dietary intake of particulate matter should be avoided to prevent diverticulitis.' Nuts, seeds not associated with diverticulitis risk The new research included 29,916 questionnaires received from females with no previous history of diverticulitis, inflammatory bowel disease, or cancer. The participants were enrolled in the Sister Study, a long-running project to learn more about those who are siblings of someone with breast cancer. Of those females, 1,531 cases of diverticulitis were identified. Beyond finding that nuts and seeds do not increase the risk of diverticulitis, the researchers also found that the healthy dietary patterns were not associated with any risk of underlying diverticulitis. Shabnam Sarker, MD, an assistant professor of medicine in the department of gastroenterology, hepatology, and nutrition at Vanderbilt University Medical Center, said that the findings support patients and clinicians in finding the best ways to reduce the risk of symptoms. Sarker wasn't involved in the new study. 'I think this study kind of confirmed what we've been doing in our practice, or at least I've been doing in my practice for a long time,' Sarker said. 'So, I think earlier in our training, or years ago, we used to think that seeds were at risk of being trapped within diverticula… and we thought maybe that was a trigger on why some people had recurrent disease. And then through [further research] we've realized that a high fiber diet is really the best for overall colon health,' she noted. How is diverticulitis treated? Diverticulitis is a complication of diverticulosis, where diverticula, commonly known as pouches, develop within the colon. When these pouches become inflamed, pain, bloating, and the potential for more serious complications like abscesses, obstructions, and perforations may occur. Diverticulosis is common, particularly among older adults. The National Institutes of Health (NIH) estimates that around 30% of U.S. adults ages 50–59 develop diverticulitis, and more than 70% of adults 80 and older are diagnosed with the disorder. Sometimes called 'uncomplicated diverticulitis,' diverticulosis requires minimal intervention, such as antibiotics and monitoring. Diverticulitis, however, is much less common, affecting around 5% of people with diverticulosis. Complicated diverticulitis often leads to more intense treatment options, like surgery. Those involved in the study were found to have 1,531 cases of diverticulitis, less than a third of which required hospitalization. Of those 1,531 cases, 14% required surgery and 58% had two or more recurrences. Surgery is most often required when the condition creates perforations or abscesses that require intervention, much more common for those who have had diverticulitis multiple times. Shawn Khodadadian, MD, medical director of Manhattan Gastroenterology, told Healthline there are multiple avenues to treatment for those having to manage diverticulitis symptoms. Khodadadian wasn't involved in the new study. 'Generally, outpatients can be managed with pain control and oral analgesics as well as a liquid diet in the outpatient setting for uncomplicated diverticular disease,' he said. 'Oftentimes, especially in higher-risk patients, antibiotics are prescribed when indicated. Antibiotics are not always needed to manage uncomplicated outpatient diverticulitis in otherwise healthy, stable patients, but this should be left up to your doctor after a complete evaluation,' he continued. James Cox, MD, a gastroenterologist and assistant professor at Texas Christian University, added that it's important for people with diverticulitis to understand the limits of preventive medicine regarding the condition. Cox wasn't involved in the new study. 'There's nothing patients can do to prevent the development of the diverticuli or diverticulosis,' he told Healthline. Diverticulitis may become severe One of the common surgeries to treat complicated diverticulitis is a colectomy, which involves removing a segment of the intestine and sewing it back together. In more serious cases, a temporary colostomy bag may be required to give the area time to heal before reattachment can occur. Cox noted the most serious complications are often perforations. 'If there's a perforation, then you have colonic content in the abdominal cavity, and that's bad. That's very hard to sew right back up. Patients will often need a temporary colostomy bag for a few months, let everything calm down, and then they get hooked up.' Sarker added that, for her patients, it can be helpful to explore options with a colorectal surgeon earlier rather than later. 'If they're interested, or would like to even speak to somebody as a consultation [like] a colorectal surgeon, I usually will set them up as a consultation. Even if they're not sure, just to have met someone and talk about the option for this, so that they feel like they're empowered, especially in a condition that seems very difficult to control,' she suggested. Underlying causes of diverticulitis not understood Sarker said that part of the patient-clinician relationship is building a space where conversations can flow about conditions like diverticulosis, the reason for which is largely unknown. Future research can investigate the different risk factors for a condition in which the underlying cause is not entirely understood. The questionnaire-based nature of the new study highlights the challenges of nutrition research. A double-blind study with a placebo, considered the gold standard in research studies, is very difficult to conduct with food. Cox is hopeful that further research into the gut and nutrition can help shed light on why diverticulosis happens. Khodadadian believes that more research can and should be done into the particulars of how diets can improve patients' outcomes. Sarker said she'd like to see more research that prioritizes women and the role nutrition has on the gut.
Medscape
06-05-2025
- Health
- Medscape
Confirmatory Test for Primary Aldosteronism May Slow Care
For patients who already have a positive result on a screening test for primary aldosteronism (PA), confirmatory testing with the seated saline suppression test (SSST) adds little to the diagnostic work-up and may delay proper and timely care, according to a study published in the Annals of Internal Medicine. The SSST may misinform treatment decisions and lead to missed chances for intervention 'even in patients who would clearly respond to treatment,' the authors wrote, led by Alexander A. Leung, MD, MPH, Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada. The research setting was the Endocrine Hypertension Clinic in Calgary, and the study included 156 adults with a positive screening result for PA. The SSST involved administering 2 L of 0.9% sodium chloride intravenously over 4 hours. 'The results of our study suggest that removal of routine confirmatory testing from the diagnostic care pathway for PA may help to improve diagnostic accuracy and reduce the time needed for diagnosis and treatment for most patients,' the authors wrote. Fewer Than 1% of Patients With PA Get Treatment PA accounts for 10%-30% of all cases of hypertension worldwide. Diagnosing it is important not just because of the prevalence but because there are highly effective, disease-targeted treatments. But fewer than 1% of patients with PA get treatment because of the lack of awareness and barriers raised by a complex diagnostic pathway. That's why Leung's team set out to assess in a blinded clinical trial whether confirmatory testing was worth the complications it added to the process. 'We selected the SSST because many believe it to be the most reliable confirmatory test for PA,' the authors wrote. 'We used response to targeted treatment as the reference because it is pragmatic and relevant to patients.' They found that 'the SSST could not discriminate between response statuses (area under the curve, 62.1%; 95% CI, 45.1%-79.1%). The positive and negative likelihood ratios were equivocal for aldosterone cutoffs ranging from 140 to 300 pmol/L. These findings remained consistent after differences in treatment, occurrence of hypokalemia, and laboratory assay used were accounted for.' 'Limited Application in the US' However, Joshua D. Lenchus, DO, RPh, internal medicine specialist and American Osteopathic Association board member, who was not part of the study, said the study 'likely has relatively limited application in the US.' He explained that some patients with suspected primary PA do not require a confirmatory test, and of those currently available, the SSST is not universally applicable. 'For example, it is generally not used in patients with uncontrolled blood pressure or those with a history of congestive heart failure. Running an intravenous infusion of saline over 4 hours is easier in an inpatient setting but may be cumbersome in an outpatient office,' he told Medscape Medical News . He said he was also surprised to find that 'less than 30% of study participants had resistant hypertension, less than 15% were under the age of 40, and more than 50% were over the age of 60. Typically, the incidence rate of primary aldosteronism is highest in females under 40 years of age with resistant hypertension and hypokalemia.' Lenchus said the SSST is one of several confirmatory tests for PA used in the United States, including the captopril challenge test and the fludrocortisone suppression test, although no gold standard exists as yet. He said he would like to see a follow-up with a larger cohort of patients, perhaps comparing several confirmatory tests head-to-head to identify a standard. The study was funded by the Canadian Institutes of Health Research, Hypertension Canada, and the Heart and Stroke Foundation of Canada.
