Comparison of office, home and ambulatory blood pressure measurements in hypertensive and suspected hypertensive SWICOS participants.

PURPOSE: Hypertension should be confirmed with the use of home BP measurement (HBPM) or 24h ambulatory BP measurement (ABPM). The aim of our study was to compare measurements obtained by OBPM, HBPM and ABPM in individuals with elevated OBPM participating in the population-based Swiss Longitudinal Cohort Study (SWICOS). MATERIAL AND METHODS: Participants with OBPM ≥140/90 mmHg assessed their BP using HBPM and ABPM. The cut-off for hypertension was ≥135/85 mmHg for HBPM, ≥130/80 mmHg for ABPM. White-coat hypertension (WCH) was defined as normal HPBM and ABPM in participants not taking antihypertensive drugs. Uncontrolled hypertension was defined as hypertension in HBPM or ABPM despite antihypertensive treatment. RESULTS: Of 72 hypertensive subjects with office BP ≥140/90 mmHg and valid measurements of HBPM and ABPM, 39 were males (aged 62.8 ± 11.8y), 33 were females (aged 57.4 ± 14.2y). Hypertension was confirmed with HBPM and ABPM in 17 participants (24%), with ABPM only in 24 further participants (33%), and with HBPM only in 2 further participants (3%). Participants who had hypertension according to ABPM but not HBPM were younger (59 ± 11 y versus 67 ± 16 y; p < 0.001) and more frequently still working (83% versus 23%; p < 0.001). The prevalence of WCH was 28%. Among the 32 subjects taking antihypertensive drugs, uncontrolled hypertension was found in 49%. CONCLUSION: This population-based study found a high prevalence of WCH and potential uncontrolled hypertension among individuals with elevated OBPM. This study, therefore, supports the ESH recommendations of complementing OBPM by ABPM or HBPM. The use of HBPM instead of ABPM for the confirmation of hypertension in individuals with elevated OBPM might lead to underdiagnosis and uncontrolled hypertension, in particular in the younger working population. In these individuals, this study suggests using ABPM instead of HBPM.

What is already known?Comparing blood pressure measurements in the doctor's office or clinic (OBPM) with out-of-office measurements (either self-measurement at home (HBPM) or ambulatory over 24 hours during both day and night times (ABPM)) improves the accuracy of hypertension diagnosis.Why was the study done?This study was done to provide additional information by comparing HBPM and ABPM in individuals with elevated OPBMs (≥140/≥90mmHg), who participated in the Swiss Longitudinal Cohort Study (SWICOS)What was found?Our study confirmed differences between office and out-of-office measurements. In 60% of the study participants, ABPM or HBPM confirmed the elevated OBPM but only around half of these participants were treated with antihypertensive drugs. A high proportion of the participants (28%) had white coat hypertension.What does this study add?Our study adds to the literature already available on this issue by reporting on data obtained from a cohort of individuals living in a countryside area of Southern Switzerland.This study also showed that HBPM might underestimate BP in the younger working population.How might this impact on clinical practice?The findings of this population-based study support the European Society of Hypertension recommendations for wider use of out-of-office blood pressure measurement for the confirmation of hypertension in individuals with elevated OBPM to avoid underdiagnosis and uncontrolled hypertension.In the young working population, ABPM should be used instead of only HBPM to confirm hypertension.

Laws can be unethical.

ICU teams have the difficult emotional burden of continuing complex life-sustaining therapy beyond the limits of what is felt to be reasonable. Among the reasons leading to a delay in the withdrawal of intensive therapy is the unwillingness or unpreparedness of the team or family members, or inadequate laws. We all have the responsibility to promote a legal framework allowing end-of-life decisions that ensure the autonomy, dignity and integrity of all citizens, in addition to the humane practice of medicine.

How important is malnutrition? A prospective study in internal medicine.

BACKGROUND/OBJECTIVE: Data about the prevalence of malnutrition on hospital admission vary and follow-up data are scarce. We assessed the nutritional status of unselected patients on admission and discharge. SUBJECTS/METHODS: A total of 430 consecutively admitted patients were assessed and 168 patients hospitalized > or =6 days were reassessed on discharge. Assessment was carried out by the Mini Nutritional Assessment (MNA), weight and anthropometric measurements, bioelectrical impedance analysis, biochemical markers and a subjective clinical assessment by the physicians in charge. RESULTS: On admission, 47% of all patients were overweight (body mass index, BMI >25 kg m(-2)) and 8% underweight (BMI<18.5 kg m(-2)). In terms of the MNA 70% were adequately nourished, 20% were at risk for malnutrition and 10% were malnourished. By clinical judgment alone 18 (4.3%) malnourished patients according to MNA were missed. The 44 malnourished patients according to the MNA had significantly lower values for BMI, fat-free mass, fat mass, waist circumference, triceps skinfold thickness, hemoglobin, albumin, prealbumin, total cholesterol but higher values for C-reactive protein. Of the 168 patients staying > or =6 days in hospital, 57% lost and 39% gained weight. Only 1.9% of all patients (8 of 430) were malnourished and lost further weight during hospitalization. CONCLUSIONS: We found a low prevalence (10%) of malnourished patients on admission. Clinical judgment and to some extent anthropometrical measurement were helpful for assessing the nutritional status, laboratory values were not.

The effect of exercise, alcohol or both combined on health and physical performance.

Alcohol (ethanol) is consumed on a daily basis by a large fraction of the population, and in many countries, light-to-moderate alcohol consumption is considered as an integral part of the diet. Although the relationship between alcohol intake and obesity is controversial, regular consumption of alcohol, through its effects in suppressing fat oxidation, is regarded as a risk factor for weight gain, increased abdominal obesity and hypertriglyceridemia. Indeed, alcohol taken with a meal leads to an increase in postprandial lipemia-an effect on postprandial metabolism that is opposite to that observed with exercise. Furthermore, although regular exercise training and/or a preprandial exercise session reduce postprandial lipemia independently of alcohol ingestion, the exercise-induced reduction in postprandial lipemia is nonetheless less pronounced when alcohol is also consumed with the meal. Whether or not alcohol influences exercise and sport performance remains contradictory. It is believed that alcohol has deleterious effects on the performance, although it may contribute to reduce pain and anxiety. The alcohol effects on sports performance depend on the type and dosage of alcohol, acute vs chronic administration, the alcohol elimination rate as well as the type of exercise.

[Prevalence of overweight and obesity in Swiss adolescents]. / Prävalenz von Ubergewicht und Adipositas bei Kantonsschülerlnnen in St. Gallen.

Overweight and obesity are the most important modulators in the development of chronic diseases. Body weight status in adulthood is often already determined in childhood and adolescence. In this study we evaluate possible threats and the prevalence of overweight and obesity among students of the Kantonsschule Burggraben in St.Gallen. Different anthropometric parameters (e.g. size, weight, circumference of waist and hip, body composition by BIA) were assessed among 552 students and different life-style factors as well as risk factors were assessed with a self-administered questionnaire. Using the IOTF-definitions between 6.12-8.18% of students were overweight and 1.08-2.23% were obese. Male students with the highest media consumption (MC) (around 4 h/d) had a higher BMI (kg/m2) than students with lower MC (around 2 h/d) or the lowest level of MC (approximately 1 h/d) (22.83 +/- 0.46 kg/m2 vs. 21.51 +/- 0.21 kg/m2 and 21.60 +/- 0.39 kg/m2; ANOVA p = 0.008). Similarly body composition was affected: students with the highest media consumption had the highest amount of body-fat mass: 12.69 +/- 0.66% vs. 11.05 +/- 0.34% and 10.69 +/- 0.62% (ANOVA p = 0.026) compared to medium and low MC, respectively. There was no correlation between the BMI, the body fat mass and the MC among female students. According to the level of activity male students with a high level showed a significant lower BMI than students with a lower level of physical activity (21.70 +/- 0.21 kg/m2 vs. 22.05 +/- 0.33 kg/m2; p = 0.016). The body fat mass was also lower for higher levels of physical activity (9.57 +/- 0.65% vs. 12.69 +/- 0.86%). Among female students the level of physical activity modulated the body fat mass (high level 20.66 +/- 0.52% vs. low level 23.53 +/- 0.58; p = 0.005) but had no effect on the BMI. Risk factors for obesity such as physical activity patterns are established in childhood and early adolescence. Preventive strategies have to be implemented as early as possible.

[Epidemiology of over- and underweight in Swiss college students]. / Prävalenz von Uber- und Untergewicht in einer Mittelschulpopulation.

Overweight and obesity rates are increasing worldwide. In this study 409 adolescents and young adults (age range 15-22 years) in a Swiss college were studied. The prevalence of overweight was 6.13% in the girls and 5.95% in the boys. 9.52% of the boys and 16.51% of the girls were underweight (BMI < 18.5 kg/m2). 16.98% of the girls had a fat mass > 30%. 2.98% of the boys had a fat mass of > 20%. Male adolescents with a fat mass > 15% judged their physical activity on a visual analogue scale (VAS) significantly lower than male adolescents with a fat mass of < 15% (mean +/- SD VAS score: 4.49 +/- 2.08 vs. 6.00 +/- 2.08, p = 0.03). The same was found in female adolescents: girls with a fat mass > 30% reported a lower physical activity level than females with a fat mass < 30% (mean +/- SD VAS score: 4.84 +/- 1.74 vs. 5.68 +/- 1.82, p = 0.04). Obesity and fatness, but also underweight, is a serious problem in Swiss adolescents. Well chosen public health strategies to address both sides of the energy balance equation are strongly needed.

My brother has severe sepsis--should he receive Xigris?

Six years ago, a publication in a quite well known scientific medical journal brought hope and a good dose of optimism to sepsis therapy and the critical care community. For the first time, a careful randomized controlled trial in patients with severe sepsis or septic shock seemed to show a clearly beneficial effect of a new drug, i.e. of activated recombinant human protein C. This new treatment possibility was welcomed as an important breakthrough and a hope for a better management of a deadly disease. However, further evaluation of the results of the trial and new investigations did not confirm entirely the initial optimism. As a consequence, the adequate indications for this expensive drug remain controversial.

[Measurement of body composition in daily practice]. / Messung der Köperzusammensetzung im Praxisalltag. Genauigkeit sowie Sinn und Unsinn von Geräten zur Bestimmung der Körperzusammensetzung.

During the last few years bioimpedance analysis (BIA) devices have been heavily promoted for body composition measurements in daily medical practice. The accuracy of these devices is not exactly known. Accordingly we compared in this study 6 different BIA devices, 3 different skinfold callipers with dual energy x-ray absorptiometry (DXA) as the reference methodology. The correlation coefficient between the fat mass assessed by the BIA devices as compared to the DXA methodology varied between r = 0.880 and r = 0.947 (p for all < 0.001). The accuracy of the measurements was better in women than in men and better in individuals with a BMI > 25 kg/m2 than in individuals with a BMI < 25 kg/m2. For daily use the BIA devices are much more user-friendly than the skinfold callipers. It is obvious that the use of the BIA measurement in daily practice does not help much in the assessment of obesity but more so in the assessment (quantification) of the lean body mass (LBM).

[Every step counts: what is the physical activity level of our patients? A pedometer study]. / Jeder Schritt zäh it: Wie viel bewegen sich unsere Patienten? Eine Pedometer-studie.

The prevalence of obesity is increaseing worldwide and thus enhancing the development of the chronic diseases. Physical activity represents not only an important modulator of the energy balance but physical exercise represents a key feature for chronic disease risk reduction independently from body weight. In this study we assessed physical activity by counting the steps with the help of a pedometer in 49 consecutive patients (33 women and 16 men) of the obesity- and hypertension clinic at the Medical Policlinic at the University Hospital in Zurich. 29 of the patients were obese (mean +/- SD BMI 35.3 +/- 5.5 kg/m(2)), eleven overweight (27.6 +/- 1.1 kg/m(2)) and eight of normal body weight (22.7 +/- 1.5 kg/m(2)) according to the WHO-classification. The mean +/- SD steps per week of the whole population was 67917 +/- 33856. Patients with a normal weight had more steps per week, but the difference did not reach significance as compared to the overweight or obese subjects. Only on Sunday the normal weighted patients had significantly more steps than the other groups. The data suggest that strategies to enhance physical activity on the weekend should be encouraged in all subjects, especially however in those with an increased body weight.

[Body weight and physical activity: how much is too little? How much is enough?--a study in recreational cyclists]. / Körpergewicht und körperliche Aktivität: Wie viel ist zu wenig? Wie viel ist genug? Eine Studie bei Hobbyradfahrern.

Body weight and body mass index (BMI) were studied in non professional cyclists. BMI increased from 22.2 +/- 2.3 kg/m2 (20 to 29 y) to 23.8 +/- 1.7 kg/m2 (55 to 77 y) (mean +/- SD). The mean increase per decade was 0.5 kg/m2, markedly less than in the general Swiss population (0.8 to 1.0 kg/m2). Overweight (BMI 25.1-29.9 kg/m2) prevalence increased from 7.4% (20 to 29 y) to 25.5% (55 to 77 y) and obesity (BMI +/- 30.0 kg/m2) was rare (0.2%, n = 1). The amount of sport correlated negatively with BMI change. A high amount of moderate to heavy physical activity (five hours weekly) was required to avoid an increase in BMI. This amount is to high for the general population. Thus, control of energy intake should be advised together with physical activity.

Obesity during growth in Switzerland: role of early socio-cultural factors favouring sedentary activities.

Depending upon age, gender and geographical area, 3-20% of the children and young adolescents in Switzerland are overweight and 0-6% obese, using the criteria of the International Obesity Task Force. The most likely explanation for this increasing prevalence of overweight and obesity is a decline in physical activity, and hence diminished energy expenditure that is not matched by a corresponding reduction in energy intake. In this paper, we first review the epidemiological situation in Switzerland regarding the rising prevalence of obesity and the decline in physical activity, and then focus upon the environmental, social and cultural factors that predispose children to sedentary behaviours. Several of these socio-cultural factors and in particular television viewing and poor-parental model, confer early 'learned behaviours' for low physical activity which track throughout growth into adulthood, and which also predispose to the overconsumption of less healthy foods. It is time to focus on preventive strategies directed at curtailing these 'learned behaviours', that we have acquired during the transition from the stone-age to the chip-age, if we want to hold the current pandemic of obesity.