Isolated systolic hypertension (ISH) – an increase in the higher of the two numbers when blood pressure (BP) is measured – is the commonest type of high BP in older people over the age of 60. The systolic pressure used to be dismissed as less important than the lower number – diastolic BP – but studies have shown that it is associated with increased risk of cardiovascular disease. ISH accounts for up to 75% of the overall incidence of uncontrolled hypertension in the elderly and appears to be more common in women than men.
People with diabetes used to be advised to watch their carbohydrate – particularly sugar – intake. But dietary recommendations have developed over the past few years so that they are now similar to the healthy diet that we should all be eating. Are there any remaining differences in what we should be telling patients with diabetes about their diet? Fewer than you might think. In this article we take a 'supermarket tour' that explains what patients with diabetes should be putting in their trolleys and what they should be leaving on the shelves.
An increasing number of patients are prescribed statins because of the growing evidence that they can dramatically reduce cardiovascular events. However, the withdrawal of one statin – cerivastatin – some time ago may have made some patients concerned about their safety. What should we be telling patients about the benefits of statins, how long they should take them for and whether there are any risks with these widely used agents?
For people with long-term conditions, self-care can have as much, if not more, influence on their health than prescribed medication and treatment. Yet, in many cases, healthcare professionals become frustrated when attempts to improve peoples' self-care behaviours prove unsuccessful. This article looks at some of the reasons why it can be difficult to encourage people with diabetes or cardiovascular disease to look after themselves effectively; what types of practice can help us to increase people's success in managing long-term conditions; and how we can incorporate empowering techniques in our day-to-day consultations.
Patients with diabetes are at high risk of cardiovascular disease and aspirin is an important part of prevention strategies. Although it is effective and relatively well-tolerated, studies have shown that many patients with diabetes are not taking aspirin. In this article, we review why aspirin should be considered in patients with diabetes, the benefits it might achieve and areas where caution is required.
Most people with hypertension are diagnosed and managed on the basis of blood pressure (BP) measurements taken by healthcare professionals in the surgery. Although clinic readings remain the accepted method of measuring and monitoring BP, they are widely acknowledged to be prone to inaccuracies, such as the infamous 'white coat effect' that can lead to artificially high readings. In addition, the relatively small number of readings generally taken in the clinic offers only a 'snapshot' look at BP levels that may not reflect real values.
There is increasing evidence that the use of self BP measurement – with patients monitoring their own BP at home – may provide some advantages over BP measurement in the clinic or surgery. These include potentially more accurate readings and average values that are more reproducible and reliable than traditional clinic measurements. In this article we look at the evidence for the use of home BP monitoring and the accuracy of home monitors.
The management of cardiovascular disease (CVD) in primary care has been transformed in recent years, particularly with extensive use of statins in secondary prevention. But what about the less high-tech approach of getting patients to eat more healthily? Dietary advice has traditionally been offered primarily to those needing to lose weight or lower their lipid levels. But more recently, systematic reviews have shown good evidence that dietary changes can reduce mortality and morbidity in addition to modifying some risk factors in patients with coronary heart disease. Evidence to date suggests similar benefits of healthier eating are likely in primary prevention. In this new series – Food for Thought – we sort the wheat from the chaff when it comes to dietary advice for patients with cardiovascular disease. This article will focus on the benefits of oily fish, with the good news that simply increasing oily fish intake achieves major benefits.
Stroke is common, affecting around one in four people over the age of 45 at some time in their lives. Increasing age is a major risk factor for stroke, so the numbers of people suffering a stroke will increase with the ageing population. Primary care teams have a central role in providing effective secondary prevention, but because patients often fall between primary and secondary care, things may be missed. Taking a systematic approach to assessing risk factors, such as blood pressure, and treating them effectively can significantly reduce further stroke risk.