ACE inhibitors

We've got a lot of drug choices availble to lower high blood pressure. Some older drugs that effectively lowered pressure have fallen by the wayside because, while they enable patients to reach a satisfying 'numbers' goal, that success did not translate out into a decrease in risk of future heart attack or stroke which is really the point of treating hypertension.

The ACE inhibitors are a class of blood pressure meds that remain on the "A" list. These drugs work by inhibiting a cascade of events initiated by the kidneys that result in the constriction of blood vessels. When blood vessels narrow, the same amount of fluid (your blood volume) is now in a smaller space, and pressure rises. These angiotensin converting enzyme inhibitors partially block the conversion of an inactive substance produced by the liver--angiotensinogen--to an active vasoconstricting molecule called angiotensin.

Not only do ACE inhibitors lower pressure and thus lower risk of heart attack and stroke, they also promote normal blood vessel behavior independent of their effect on blood pressure. Furthermore, new evidence suggests that several drugs in this category help peope hold onto their marbles through the years.

Several ACE inhibitors cross the 'blood-brain barrier,' the tight junction between the blood and all the good and bad things coursing through it and the delicate nerve cells in the noggin. Persons of age taking these drugs, including captopril, lisinopril, ramipril, and fosinopril, were followed over six years time for the development of dementia as a function of their blood pressure medication choice during the Cardiovascular Health Study.

Those oldsters on brain active ACEIs were 50% less likely to demonstrate a decline in mental functioning during the study. The lead investigator concluded, "If an ACE-inhibitor is indicated, I would recommend using one that crosses the blood-brain barrier."

At a time in our lives when we are intent on getting all parts to the finish line, going for the 'three-for-one' action of these drugs seems like a great strategy.

Where is Femail Doc?

Over at my mom's house, getting us both through life, one day at a time. Check for progress notes at Doc of Ages. Loook for more up-to-date medical news here sometime in the future.

I wrote last week in Doc of Ages (www.vintagefemail.blogspot.com) about the increasing evidence that regular use of aspirin can prevent cancer versus the pesky little problem of gastric hemorrhage which may occur without warning in aspirin users.

Over 5,000 British physicians and some 2,500 TIA victims in the UK just added the weight of their evidence on aspirin use and colon cancer risk. The conclusion? Five years of daily intake of 1 standard asprin tablet (325 mg) resulted in a 37% decrease in incidence of colorectal cancer, and 10 or more years led to an impressive 74% risk reduction.

Investigators noted that these studies showed a more robust chemopreventive effect for aspirin compared with earlier trials because the daily dose was higher. They also note that nothing has changed about that annoying little stomach bleeding thing from regular aspirin use, but perhaps these strong statistics mean that cancer prevention benefits outweigh those risks for high risk patient populations.

In our study, if every woman ate a healthy diet, exercised a half hour a day, was not overweight, did not smoke, and drank a small amount of alcohol, over 90 percent of diabetes cases would have been eliminated...This is, of course, a hypothetical concept.
--Frank Hu, HSPH, Harvard School of Public Health

There you have it, diabetes 90% eliminated with a few small lifestyle adjustments. This analysis is based on data from 80,000 nurses followed over 16 years for the development of diabetes as correlated with their daily habits.

The new rusty nail?

Yech, tongue piercing, can't imagine how anyone could go through with it. An article in Head & Neck several years back wonders if the metal barbell through the tongue could become the 'new rusty nail' based on a case report of tetanus that developed post-piercing in one young lady.

Doctors in Italy reported that an 18-year old woman developed episodic 'electric shock' sensations in her face due to inflammation in a facial sensory nerve from a tongue stud. Other complications noted in the medical literature include a blood-borne infection resulting in endocarditis (heart infection) and development of a brain abscess.

If we have any influence on our teenaged children's self-expression, we should discourage this particular outlet. Better a safety pin through the eyebrow than a stud through the tongue.

Old advice found in a new issue of JAMA

May I never see in the patient anything but a fellow creature in pain.
--Oath of Maimonides

A Complication of Forceful Nose-Blowing

I've been struggling with the remains of a cold and the never-ending drainage from the ethmoid sinus that sits right behind my left eye. So I was not happy when I was flipping through The American Journal of Medicine today and the above title caught my eye.

You're probably familiar with the medical myth that your eyes may get stuck if you cross them. In the realm of the possible, small boys could put their eyes out if playing with BB guns, and it is possible to stick a pencil through your posterior pharynx if you run through the house with the pencil in your mouth and fall flat on your face. But is it possible to blow your brains out by blowing your nose?

Apparently yes, and there's a scary MRI image in the AJM to prove it. Some old guy who had the habit of honking heartily into his hanky felt a 'pop' after one particularly forceful blow and immediately experienced pain above his left eye. The pain worsened over 4 days, he then developed a fever and lapsed into a coma.

Apparently his nose-blowing ruptured the membranes covering his brain and forced air plus bacteria into the space around his brain. After big time antibiotics, he improved, woke up, and presumably now blows gently and genteely.

And so will I!

The dirt on dirt

It's good for you. I wish I could get my son to accept this, but the fact is, when I drop food on the ground as I prepare dinner, it's better that he doesn't know that I just pick it up and put it back in the bowl.

Perhaps Dr. Yulia Iossifova of the University of Cincinnati should come to dinner to help me explain (as we pick cat hair off the fallen lettuce). Here's what she has to say:

The immune system's protective effects only appear to occur when there are high levels of microbial exposure. Cleaner environments do not have enough microbial components to trigger the immune system response.

She and her colleagues enrolled 574 families with newborn infants as part of the Cincinnati Childhood Allergy and Air Pollution Study. At least one parent in each family tested positive on a skin prick test for a panel of allergens.

The investigators then crawled around the family homes in an infantile sort of way collecting samples of dust and mold from the babies' environments. They checked the house sweepings for levels of a protein found in the cell wall of fungi; the higher the levels, the more mold at baby level. This protein is believed to cause respiratory symptoms in adults. Months laters, the tots were studied for allergic responses to skin tests and a history of wheezing episodes, and signs of allergies were correlated with levels of mold in the house.

Turns out, the moldier the floorboards, the less likely the offspring to wheeze in an allergic sort of way. Conversely, those babes in households where the parents actually found time to scrub and disinfect under chairs and in corners were far more likely to suffer from allergy-related respiratory distress.