European guidelines on lifestyle changes for management of hypertension : Awareness and implementation of recommendations among German and European physicians.

BACKGROUND: In the 2013 European Society of Hypertension (ESH) and European Society of Cardiology (ESC) guidelines for the management of arterial hypertension, six lifestyle changes for treatment are recommended for the first time with class I, level of evidence A. We initiated a survey among physicians to explore their awareness and consideration of lifestyle changes in hypertension management. METHODS: The survey included questions regarding demographics as well as awareness and implementation of the recommended lifestyle changes. It was conducted at two German and two European scientific meetings in 2015. RESULTS: In all, 1064 (37.4% female) physicians participated (806 at the European and 258 at the German meetings). Of the six recommended lifestyle changes, self-reported awareness was highest for regular exercise (85.8%) followed by reduction of weight (66.2%). The least frequently self-reported lifestyle changes were the advice to quit smoking (47.3%) and moderation of alcohol consumption (36.3%). Similar frequencies were observed for the lifestyle changes implemented by physicians in their care of patients. CONCLUSION: A close correlation between awareness of guideline recommendations and their implementation into clinical management was observed. European physicians place a stronger emphasis on regular exercise and weight reduction than on the other recommended lifestyle changes. Moderation of alcohol consumption is the least emphasized lifestyle change.

[Management of different cardiovascular risk factors with a combination tablet (polypill)]. / Management verschiedener kardiovaskulärer Risikofaktoren mit einem Kombinationspräparat ("Polypill").

BACKGROUND: The multifactorial origin of cardiovascular diseases has led to polypharmacy in primary and secondary prophylaxis with evidence-based medications, such as statins, antihypertensive drugs and platelet aggregation inhibitors. The number of prescribed drugs correlates inversely to adherence and can lead to treatment failure. Fixed-dose combination drugs (polypills) could increase the medication adherence of patients, reduce risks and prevent cardiovascular events. METHODS: This review is based on publications that were retrieved from Medline (via PubMed) and The Cochrane Library. The clinical database ClinicalTrials.gov. was also considered. RESULTS: In the studies on primary prevention conducted to date, fixed-dose combinations showed a superior control of risk factors, e.g. hypertension and low-density lipoprotein (LDL) cholesterol compared to placebo and at least non-inferiority compared to usual care. In secondary prevention, the effect of the polypill is mostly on the reduction of blood pressure and LDL cholesterol in non-adherent patients; however, evidence that fixed-drug combinations reduce cardiovascular morbidity and mortality compared to standard therapy is lacking. CONCLUSION: The polypill can be considered as an alternative to polypharmacy after a risk-benefit assessment, especially in non-adherent patients. Ongoing studies are investigating the effect of the polypill on cardiovascular events. Current polypills are limited by the lack of sufficient dosages of the individual components to avoid overtreatment and undertreatment at the individual treatment level.

[Ambulatory 24-h blood pressure measurement in patients with glaucoma]. / Bedeutung des 24-Stunden-Blutdruckprofils beim Glaukom.

The arterial blood pressure is an important determinant for the development and progression of glaucoma. Some relevant information can be obtained only by ambulatory 24-h blood pressure measurement (ABPM). White-coat hypertension can be excluded by ABDM and the variability of blood pressure during 24 hours can be assessed. 24-h mean blood pressure should be < 130/80 mmHg. In contrast, diastolic blood pressure values below 60 mmHg during the night have been identified as a progression factor in glaucoma, as well as reductions of night-time systolic blood pressure of less than 10 % (non-dipper) and of more than 20 % (extreme dipper). The significance of the 24-h blood pressure profile for the cooperation of ophthalmology and internal medicine is discussed.

[Improvement of management of hypertension by implementation of alcohol screening and subsequent interventions in primary practice]. / Verbessertes Hypertonie-Management durch Alkohol-Screening und Folgeinterventionen in der Hausarztpraxis.

Hypertension and alcohol use are both part of the five most important risk factors for burden of disease in Western Europe, mainly because of their impact on non-communicable diseases (NCD). Both risk factors are prevalent with high overlap among patients in primary care. Implementation of a screening for alcohol among patients of hypertension in primary care followed by brief intervention for problem alcohol use or formal treatment for people with alcohol dependence could constitute an important step to reach the goals of the Global WHO Action Plan for Prevention and Control of NCD. In addition, such an intervention could improve the management of hypertension. In a working group of experts from clinical practice and research the rationale and potential barriers for this intervention were discussed and steps for implementation in primary care were developed.

Impact of oral vitamin C on histamine levels and seasickness.

BACKGROUND: Seasickness is a risk aboard a ship. Histamine is postulated as a causative agent, inversely related to the intake of vitamin C. Persons with mastocytosis experienced improvement of nausea after the intake of vitamin C. OBJECTIVE: To determine whether vitamin C suppresses nausea in 70 volunteers who spent 20 minutes in a life raft, exposed to one-meter-high waves in an indoor pool. METHOD: Double-blind placebo-controlled crossover study. Two grams of vitamin C or placebo was taken one hour before exposure. Blood samples were taken one hour before and after exposure to determine histamine, diamine oxidase, tryptase, and vitamin C levels. Symptom scores were noted on a visual analog scale. On the second day the test persons were asked which day they had felt better. RESULTS: Seven persons without symptoms were excluded from the analysis. Test persons had less severe symptoms after the intake of vitamin C (p < 0.01). Scores on the visual analog scale were in favor of vitamin C, but the difference was not significant. Twenty-three of 63 persons wished to leave the raft earlier: 17 after the intake of placebo and 6 after the intake of vitamin C (p < 0.03). Women (p < 0.02) and men below 27 years of age (p < 0.02) had less pronounced symptoms after the intake of vitamin C. Histamine (p < 0.01) and DAO levels were increased after the intake of vitamin C (p < 0.001) and after placebo (n.s.). The fact that the second test day was rated less stressful by most volunteers is indicative of habituation. CONCLUSIONS: Some of the data show that vitamin C is effective in suppressing symptoms of seasickness, particularly in women and men younger than 27 years of age, and is devoid of side effects. Histamine levels were initially increased after the test persons had been exposed to waves.

Correction factors for the calculation of metabolic equivalents (MET) in overweight to extremely obese subjects.

BACKGROUND/OBJECTIVES: The metabolic equivalent (MET) is a construct that is commonly used to quantify physical activity as well as exercise performance. 'One MET' is equal to a resting oxygen uptake of 3.5 ml O2 kg(-1) min(-)(1). However, this assumption is unlikely valid in obese subjects. The aim of our study was to quantify the difference between calculated and measured METs in overweight to severely obese subjects and to provide body mass index (BMI)-specific MET correction factors. SUBJECTS/METHODS: Resting oxygen uptake (VO2-REE) was measured in 1331 patients with a BMI >25 kg m(-2) (72.0% women; age: 42.5 ± 13.0 years; BMI: 42.5 ± 7.0 kg m(-)(2)) by indirect calorimetry and MET-REE, that is, VO2-REE related to body weight was calculated. Six hundred and fifty-two subjects (70.9% women) additionally underwent a bicycle cardiopulmonary exercise test for measurement of maximal MET (MET peak). RESULTS: Mean MET-REE was 2.47 ± 0.33 ml O2 kg(-1) min(-1) in women and 2.62 ± 0.34 ml O2 kg(-1) min(-1) in men, that is, markedly lower than the expected 3.5 ml O2 kg(-1) min(-1). MET-REE decreased with increasing BMI (P<0.001 for both sexes). On this dataset, gender-specific MET correction factors were developed for distinct BMI groups. During the exercise test, women performed 4.4 ± 1.3 MET peak and men 4.7 ± 1.3. After applying our correction factors, MET peak increased to 6.2 ± 1.7 and 6.1 ± 1.6, respectively. CONCLUSIONS: Data indicate that the commonly used 1-MET value of 3.5 ml O2 kg(-)(1) min(-)(1) largely overestimates values in overweight to severely obese subjects. Our correction factors can help to reduce this systematic error and thus appear to be valuable for clinical practice as well as research studies.

[Influence of asthma severity and asthma-specific knowledge on participation in physical education among children and young people with bronchial asthma]. / Kinder und Jugendliche mit Asthma bronchiale im Schulsport: Teilnahmehäufigkeit abhängig vom Schweregrad oder vom asthmaspezifischen Wissen durch Schulung?

BACKGROUND: Physical activity is an important part of the therapy of bronchial asthma. Even if there is exercise-induced bronchoconstriction in more or less all children with bronchial asthma, the goal is an almost complete participation in physical education lessons in school. The present study investigates their participation rate. In addition, the influence of the knowledge about asthma and the severity of the disease were studied. METHODS: A questionnaire on asthma knowledge and severity, participation rate and exercise-induced symptoms was used in 217 school children suffering from asthma (9 - 16 years). RESULTS: 80 % of the patients showed a regular participation in physical education. No correlation between participation and asthma severity was found. In contrast, a significant correlation between participation and knowledge about asthma could be demonstrated (r = 0.35, p < 0.01). The knowledge about asthma was better in school children who had completed any asthma education program in the past (19 %). However, there was generally an insufficient knowledge about asthma and exercise in the investigated group. 58 subjects were not familiar with pursed lip breathing and 112 participated in physical education lessons in spite of forgotten asthma medication. CONCLUSION: Our study demonstrates a moderate increase of participation in physical education lessons in school children with bronchial asthma during the last ten years. The participation rate correlated with asthma-specific knowledge, but not with asthma severity underlining the importance of education programs on asthma and exercise.

[Vascular aging, arterial hypertension and physical activity]. / Vaskuläres Altern, Hypertonie und körperliche Aktivität.

The present review delineates the significance of intima-media-thickness, arterial stiffness and endothelial function for vascular aging. There is profound evidence for an increase in intima-media-thickness and vascular stiffness not only during healthy aging but induced also by cardiovascular risk factors. There is a central role of arterial hypertension for this progression in both structural factors. In addition, both parameters are strongly associated with cardiovascular risk. Endothelial function measured as postischemic flow-mediated vasodilatation is a functional parameter which is decreased both in healthy aging and by cardiovascular risk factors. Physical activity modifies the influence of aging and risk factors on endothelial function. A positive influence of endurance exercise on vascular stiffness and endothelial function has been demonstrated in numerous studies. In long-term studies, regular physical activity has been shown to reduce the progression of intima-media-thickness. Thus, arterial hypertension accelerates vascular aging, while physical activity has a positive influence on a variety of vascular parameters associated with vascular aging.

Aerobic exercise as a therapy option for migraine: a pilot study.

Exercise is assumed to have a positive effect on migraine. However, none of the few studies on this topic can prove the expected positive influence of exercise. Therefore, the aim of this pilot study was to develop a training program suitable for migraine patients and to examine its effect on migraine. 16 patients were examined. 8 migraine patients completed a 10-week aerobic running exercise program consisting of 3 workouts per week. The program was developed by sports scientists especially to increase the fitness level. Physical fitness, i. e., physical working capacity, was assessed using a PWC 150 test. There was also a control group of 8 patients without any special physical training. Migraine patients of the exercise group showed both a reduction in the number of migraine days per month (p=0.048) and the intensity of the attacks (p=0.028). An increase in fitness level resulted in a lowered stress level. Stress strategies like "displacement activity" (r=-0.715; p=0.046), "looking for self-affirmation" (r=-0.742; p=0.035) and "feelings of aggression" (r=-0.802; p=0.017) were reduced. Increasing the level of fitness (PWC 150) is one predictor for migraine improvement (r=0.409, p=0.031). Aerobic exercise which leads to a better fitness level is an alternative therapy method for migraine.

[Effects of a telephone intervention in patients with type 2 diabetes]. / Telefonintervention bei Typ-2-Diabetikern.

BACKGROUND AND OBJECTIVE: While there are evermore therapeutic options, a continuous rise in the prevalence of type 2 diabetes mellitus has been demonstrated in epidemiological studies and is leading to an increasing financial burden on health care systems. It has been shown in a number of studies that health-related lifestyle may be influenced by a telephone intervention program. PATIENTS AND METHODS: The effect of a telephone intervention on physical activity and other important cardiovascular risk factors was investigated over a period of three months in patients with type 2 diabetes. Those in the intervention group (n=22) were phoned once weekly and only matters concerning their physical activity were discussed. The patients in a matching control group (n=20) were not phoned. RESULTS: Physical activity increased in the intervention group with a significant difference when compared to the control group at the end of the three months' intervention. At the end of the intervention weight, body mass index, waist circumference, systolic blood pressure, triglycerides and fasting blood sugar where either significantly different between the intervention and control groups (absolute values) or showed a significantly greater decrease in the intervention group. In addition there was a tendency (not statistically significant) towards an improvement in the intervention group regarding other risk factors (body fat, diastolic blood pressure, total cholesterol, LDL, HDL, HbA1c). CONCLUSIONS: These results demonstrate that a telephone intervention can increase physical activity and reduce cardiovascular risk factors. As a result it may reduce health care-related costs.

[Bronchial asthma and sport. State of knowledge on bronchial asthma of primary physical education teachers in Schleswig-Holstein]. / Asthma bronchiale und Sport. Wissensstand der sportunterrichtenden Grundschullehrer/innen in Schleswig-Holstein über Asthma bronchiale.

BACKGROUND: There is a high prevalence of bronchial asthma among school children in primary schools (age 6-10 years). Although physical exertion may induce acute episodes of asthma in the majority of children, exercise may also be an important part of the therapy for asthma and motor development of children with asthma. In the present study, the knowledge concerning asthma and exercise among teachers in primary schools was investigated. METHODS: 120 teachers of physical education in Schleswig-Holstein were interviewed concerning their baseline data (age, gender, education) and their knowledge about asthma and physical exercise. RESULTS: 44% do not plan their lessons with regard to possible stimuli for asthma attacks. Only 32 teachers prefer correct interval training and only a small minority check the asthma emergency medication before the exercise lessons. There were no differences with regard to gender, age or education of the teachers. CONCLUSION: Our data demonstrate an insufficient knowledge about bronchial asthma among the teachers we studied. Both the medical knowledge (reaction in case of acute episodes of asthma) and the principles of exercise in children with asthma were not satisfactory.

[Power training for patients with arterial hypertension]. / Ist Krafttraining für Hochdruckpatienten gefährlich? Räumen Sie mit den alten Vorurteilen auf.

Nowadays, not only endurance training but also power training is recommended for patients with hypertension. In appropriately doses programs (no forced respiration), a number of studies have documented a blood pressure lowering effect. In the elderly hypertensive in particular, positive effects of power training that go beyond the simple lowering of elevated blood pressure may be expected.

[Development of a walking stage test (PWT) for the elderly]. / Entwicklung eines Power-Walking-Stufen-Tests (PWT) für ältere Menschen.

The aim of the project promoted by the federal state of North-Rhine/Westphalia was the development of a field stage test focusing on endurance exercises of elderly people which withstand test-theoretical quality criteria, in particular that of economy. The main objectives were therefore the measurement of individual potential by measuring the heart rate, with simultaneous minimization of health risks and a close link to normal, everyday exercises. The test procedure was supposed to estimate the aerobic endurance of elderly people in order to enable us to give individual training recommendations on walking. In a three-phase procedure (laboratory and field ergometry, test development, and evaluation) with a total of 90 test persons, the individual heart rates and lactate levels were measured in 269 single tests. The findings show that an evaluation of the individual performance capability on the basis of heart rate is possible using a three-stage power walking test (PWT), without requiring maximum strain of the subjects. The PWT can therefore be seen as a diagnostic instrument available for the age group of the 60-80 year-olds, supplying a default for an individual strain dosage for walking. The test is accomplished independently of the respective age of the subjects and the result is an individual training plan for walking on the basis of an estimate of personal endurance. Developed as a staged test, the three levels requiring a 400 m walk on each level at different speeds, all the test requires is the measurement of the heart rate at the end of each level. The validity of the common guides for the planning of training by heart rate for systematic endurance training (walking) is thereby improved enabling a more individual training recommendation.