Insulin degludec: No hint of added benefit in children and adolescents

Insulin degludec: No hint of added benefit in children and adolescents: With regard to insulin degludec, no added benefit for adolescents and children with diabetes mellitus can be derived from the drug manufacturer dossier. In girls with type 1 diabetes, severe side effects were more frequent.

HIGH BLOOD PRESSURE OR HYPERTENSION

HYPERTENTION OR HIGH BLOOD PRESSURE

 

Hypertension or high blood pressure is no doubt one of the major causes for cardiac diseases,stroke,and kidney damage.But there are contraversies regarding to the measurement of blood pressure as whether they are truely representing your body health at the right time at which it is measured at the Doctor's room.Because the movement when you entered inside the hospital, your already elevated B.P by the travel movement either by walk or vehicle from your home to hospital,would elevate further and the B.P would reach its peak level when you are called by the doctor to get in.
The Blood Pressure is always said to be the basic and funtamental information with regarding to the physiology of our body.An ordinary mild fever may be some times undetected by a thermometer but a proper measurement of a spygmomanometer would reveal that.Hence measurement of blood pressure should be made by giving sufficient time to the patient to relax by the time when he arrived at the hospital.
There are BP home measurement kits are available in the market.There are many brands in various price ranges.There are electronic and nonelectronic(Aneroid) BP kits.

An aneroid BP apparatus is the one which has a rectangular bladder on one side of the cuff embedded with a calibrated dial known as the aneroid gauge with a movable pointer,a stethoscope embedded in the cuff bladder,and a bulb pump to inflate the air.The figure is shown above.This is very simple and give more accurate measurement very close to the Doctor's mercury manometer but need experience of detecting the various pulse sounds.

Measuring BP with Aneroid BP Kit

Insert all the detachable parts like the bulb,the gauge dial,and the stethoscope armed earpieces into the respective tubes.Relax by sitting in a convenient chair for five minutes.

Place the bladder on your right or left arm by putting the stethoscopic dial exactly on the brachial artery which is right around the elbowwhere the fold is formed when you bent the arm.Wrap the cuff around the arm not too tight and not too loose such that after the wrap a pointer finger can be inserted.Place the ear pieces of the steth,into your ears.Put your wrapped arm on the table with a height exactly in a line with your heart.Relax.Inflat the bulb a little high above 150 mm/Hg and slowly deflate it.watch the pulse sound carefully.

PHASES OF PULSE SOUNDS WHEN MEASURING WITH ANEROID KITS

Phase-1 After inflate the cuff more sufficiently just 5 mm/Hg above your preveously measured or assumed BP slowly deflate by releasing the bulb valve and carefully hear the faint clear murmuring and tapping sound,the point at which this sound start is the systolic pressure

Phase-2 On continue deflation at the end of the Phase-1,a murmur nd swishing sound follows.This sound is longer than the phase-1 sound. This is the Phase-2 sound and continue deflating

Phase-3 At the end of the Phase-2,the sounds are more crisp,loud and increase in intensity
Phase-4 At the end of the phase-3 the sounds become less distinct,muffled and faint like blowing.This is phase-4.
Phase-5 At the end of the phase -4 watch the disappearence of the last sound that indicate the exact beginning of the Phase-5 which should be noted down as your diastolic pressure.Then deflate the gauge commpletely.
The procedure should be repeated two or more times daily until you become familiar with the pulse sounds.Aneroid methods are as accurate as Mercury meters,less expensive,and more convenient.

MEASUREMENT WITH ELECTRONIC METERS

 

Electronic meters are available in variety of models some are manual, semi automatic (auto deflation only),some are fully automatic (Both inflate and deflate automatically) and some with printers.All are automatically measuring the pulse and pressure and will display the values digitally at the end of the measurements in an electronically calibrated dial.Most of them are working in both battery and direct current operation.

 There are various different types such as arm model to measure by arm which are fuzzy logic,wrist watch model to measure in the wrist and finger model to measure by the finger.But measuring the BP by the arm is the reliable method.Procedures are discribed in the manufacturers instruction manual comes along with the products.The testers for Consumer Reports gave brands such as Omron and Marshalls top rating for reliability and ease of use.
Blood Pressure can be defined as the product between stroke volume and heart rate multiplied by systamic vascular resistance and can be conveniently read by the following equation:-
(stroke volume x heart rate) x systamic vascular resistance

  Altering any of the above factors would result in a change in the blood pressure.

Blood Pressure composed of two parts like the pressure at which the left ventricle empties a large chunk of blood into the aorta against the systamic resistance in the aotra during the contraction of the left portion of the heart(the sound is specific as Lub) the pressure raises in the arteries is known as SystolicPressure.

When the left side relax,by the cotraction of the right side of the heart the (sound is specific as Dup) left ventricle relax,and receive a chunk of blood from the right venricle,and the pressure in the aorta lowers and is known as Diastolic Pressure.

The mean calculation of these two parts of the B.P is measured by the various spygmomanometers as we have seen above.
If the systolic raises above 120 mm/Hg and the diastolic above 80mm/Hg we should be careful about we may have the preliminary conditions of hypertension. 

Table

No  ----        category        ----                             sytolic/diastolic       

  1.   ---         High normal -----                             130/85 to 139/89

  2..   ---        Mild               ----                              140/90 to 149/99

  3.   ----       Moderate       ---                              160/100 to 179/109

  4.   ---        Severe            ---                            180/110  to  209/119

  5.  ----        Very severe   -----                          >210/120 
In the olden days the physicians did not start to worry unless the pressure reached 150/95.At present the medical field is more aggressive in assessing the patient's model condition to be normal or above the normal with a base of 120/80mm/Hg.Because blood pressure is any way is varying environementally flexuating here and there according to the emotinal feelings,situation and sorroundings of our daily routine life.A patient is said to be having high pressure only if his repeated readings show an high persistant value.First the medical field considered only the high persisting diastolic pressure as a base.But now they consider both systolic and diastolic  if above 130/90 .
But if you are above forty it is normal and not to be panic if the pressure readings are systolic 130-140 and diastolic is 90 to 100.
There are some conditions in whic care should be taken in altering the pressure by treatments.For example some studies shows that lowering the diastolic below 90mm/Hg may produce adverse effects in patients with coronary insufficiency. 

Non-Drug Therapies For Hypertension

1.Weight Reduction:-It is of no doubt that obesity plays an important role in hypertension and cardiac overload.Food control especially fat restricted and fiber rich foods are recommended and reduced intake of food with minimum excercise may certainely have an benificial impact on overweight.

Use of tobacco,and alcohol may put on overweight by depositting fats.Avoid to take more saturated fatty meals such as redmeats like mutton beaf and like meats,adulterated cooking oils,daldas etc.

Drink a tablespoon of pure honey mixed with a cup of lukewarm water in the morning wakeup on empty stomach daily is assumed to be good extra fat remover.Similary daily morning have a drink of smooth light dicoction of fresh tea is said to have beneficiary effect.

2.Helping Minerals Foods with extra calcium,megnesium,and potassium also helping to reduce blood pressure.Apricots,avocados,bananas,cocoa,dates,figs,fish,molasses,dried peaches,peanuts,peacans,potatos,raisins,sunflower seeds,wheatgerm and brewer's yeast are potassium rich.
3.Excercise Non aggressive aerobic excercises such as morning and evening walkings,cyclings,swimmings are of benificial to help blood pressure. 

Drugs Therapy

Many people are thinking that helping blood pressure to ease down  simply by taking proper medications and enjoy the freedom from diet restriction and excercises are good thing.But a trial known as Multiple Riskfactor Intervension Trial (MRFIT), was conducted for 10 years at a cost of $100 million with 12000 recruits.The results are unexpected and it explained that those who are taking medicines are dying faster than those who are not taking medicines.

Further detailed studies by The New England Journal of Medicines  based on the MRFIT findings revealed that treatments of coronary artery disease with aggressive thiazide dosing may increase the major cause of sudden deaths by heart attack.The main reason is diuretics generally causes dipletion of the major important minerals potassium and magnesium which leads to cardiac arrhythmias and cardiac arrest.
Reserpine and guanethidine(Ismelin),as they are indirectly working by blocking the secretion of the main adrenergic transmitter norepinephring from the adrenergic nerve endings they often produce unpleasant side effects such as Orthostatic hypotension and sexual dysfunction as in the case of guanethidine,CNS depression and bradycardia as in the case of reserpine.Hence these medicines are now minimised by the doctors.
Then came the betablockers.They are non selective like propranolol(Inderal),selective such as metaprolol(Lopressor),atenolol(Tenormin,Aten),betablockers with little alpha blocking capacity such as carvedilol(Coreg)and labetalol,betablockers selective at beta-1 receptor with an partial sympathetic agonism such as acebutol(Secral).These medicines are especially the beta one selective blockers are advantageous more to youngsters with minimal side effects.But people sometimes complains fatigue.cold hands,sexual difficulties,and problem controlling sugar and cholesterol.
Then came the calcium channel blockers such as Nifedypine(Adalat),Diltiazem(Dilzem) are introduced with further minimal side effects. 
Conclusively different people responded to different medicines and should be thoroughly subjected to proper evaluation. 
For a full reference ANENCYCLOPAEDIA OF HYPERTENSION