Evaluating the treatment of hypertension in diabetes mellitus: a need for better control?

Objectives To determine how well and to what extent blood pressure (BP) is controlled in diabetic hypertensive patients treated by primary care doctors, and to evaluate drug therapy in the backdrop of risk factors and laboratory findings. Methods A therapeutic audit of the medical records of diabetic hypertensives from nine primary care health centres in Bahrain. Results In 266 diabetic hypertensives (82 males and 184 females), the recommended target BP < 130/< 85 mmHg (WHO/ISH guidelines, 1999) was achieved in 20 (9.8%) with a BP of 119 ± 4/76 ± 5 mmHg. Among those who did not achieve target BP, 70 (34.5%) lacked systolic BP control (BP = 153 ± 17/79 ± 3 mmHg), four (2%) lacked diastolic BP control (BP = 123 ± 3/86 ± 3 mmHg) and 109 (53.7%) lacked both systolic and diastolic BP control (BP = 158 ± 20/94 ± 7 mmHg). The mean age of the group achieving target BP was significantly lower than the group which lacked systolic BP control (51.6 ± 9 vs. 63.5 ± 9 years; P < 0.0001). While there were no significant differences in fasting blood glucose, glycosylated haemoglobin, triglycerides, urea, creatinine, uric acid and serum electrolytes between the group achieving target BP vs. groups without target BP, a significant difference in total cholesterol was seen. Patients with ischaemic heart disease and/or isolated systolic hypertension did not achieve the target BP. Antihypertensive monotherapy was prescribed in 145 (54.5%) patients, whereas two‐ and three‐drug combinations were prescribed in 32.3 and 8.2% of patients, respectively. As monotherapy, angiotensin‐converting enzyme (ACE) inhibitors were the most frequently prescribed drugs followed by β‐blockers, calcium channel blockers (CCBs) and diuretics. As two‐drug combinations, an ACE inhibitor with a β‐blocker/diuretic and a β‐blocker with a CCB/diuretic were usually prescribed. Conclusions According to the WHO/ISH 1999 guidelines, approximately one out of 10 diabetic hypertensives achieved target BP control. In many instances, the drug therapy prescribed was inappropriate considering the comorbidity in patients and their laboratory findings. Improved BP control is needed in treating high‐risk groups such as patients with diabetes mellitus, and efforts should be made to improve the treatment of hypertension in the primary care setting.     

Pharmacotherapy and blood pressure control in elderly hypertensives in a primary care setting in Bahrain

BACKGROUND AND AIMS: Antihypertensive treatment in the elderly has important beneficial effects in terms of reduced cardiovascular morbidity and mortality. The aim of this study was to determine, in elderly hypertensives, the adherence of primary care physicians to World Health Organization/International Society of Hypertension (WHO/ISH) guidelines for the drug management of hypertension and extent of blood pressure (BP) control. METHODS: A multicentric therapeutic audit of medical records of elderly hypertensives was performed in nine primary care health centers in the Kingdom of Bahrain. RESULTS: In elderly hypertensives (> or =60 years), the WHO/ISH-1999 recommended BP targets of <140/<90 mmHg and BP<130/85 mmHg were achieved in 11.1% of elderly hypertensives and 4.1% of elderly diabetic hypertensives, respectively. Antihypertensive combination therapy was used in approximately half of the elderly. No significant difference in BP was found in elderly hypertensives treated either with monotherapy or combination therapy. As regards mono- and overall drug utilization, beta-blockers were the most frequently prescribed drugs in hypertensives, and angiotensin-converting enzyme (ACE) inhibitors in diabetic hypertensives. Diuretics and calcium channel blockers, the preferred antihypertensives for the elderly, were less often prescribed, particularly in patients with isolated systolic hypertension. CONCLUSIONS: Approximately one out of 9 elderly hypertensives and one out of 24 diabetic hypertensives achieved optimal BP control. Although preference for antihypertensives was markedly influenced by comorbidity with diabetes, tailoring of drug therapy was suboptimal and did not adhere to the recommended guidelines in elderly hypertensives. Efforts to improve the drug management of hypertension at primary care level, particularly in the elderly, are required.     

A review of some statistics on breastfeeding in Saudi Arabia

Breastfeeding is the ideal and most natural way of nurturing infants. The importance of breastfeeding has been proved unequivocally, and UNICEF and WHO have issued guidelines to ensure breastfeeding. Saudi Arabia is a country where the legislation is derived from the Quran and Hadiths. The Holy Quran says that the mothers shall give suck to their offspring for two complete years.... The majority of mothers start breastfeeding their infants but soon introduce bottles. The single most common reason cited for the early introduction of bottle feeding is that the breast milk is insufficient. Because of this tendency, many mothers practice mixed feeding. The duration of breastfeeding varies but in general it is done beyond six months, and various factors affect the duration. Researchers have recently started using the WHO recommended key breastfeeding indicators. In a study these key indicators were found to be very low. The authors feel that there is a need to revise the media campaign for promoting breastfeeding utilizing the instructions and guidance from the Holy Quran and Hadiths.     

Effect of amino acids on glucose tolerance and hyperkalemia in very low birth weight infants

OBJECTIVE: The purpose of the study was to investigate alimentation of very low birth weight (VLBW) infants and its effect on blood concentration of glucose, urea nitrogen, creatinine and potassium. METHODS: The subjects were 100 VLBW infants born between 1993-1999. The gestational age ranged from 23 to 32 weeks and the birth weight from 443 to 1470 g. Intravenous glucose infusions were begun shortly after birth, amino acids on day 3 and lipids on day 4. Blood samples were drawn for determinations of urea nitrogen, creatinine and potassium. RESULTS: Mean caloric intake of glucose rose from 24.7 kcal/kg/day on day 1 to 58.1 kcal/kg/day on day 8 (p < 0.0001) and of amino acids from 1.1 g/kg/day on day 3 to 1.9 g/kg/day on day 8 (p < 0.0001). Potassium administration increased from 1 mq/kg/day on day 2 to 1.9 mq/kg/day on day 8. Urea nitrogen was at a mean level of 21.4 mg/dl on day 4 and declined afterwards (p < 0.0001). Serum potassium levels declined from 5.9 mmol/L on day 2 to 4.1 mmol/L on day 8 (p < 0.0001), while creatinine levels remained stable. CONCLUSION: Our findings suggest that a catabolic state in VLBW infants begins to be reversed when the caloric intake of 40-50 kcal/kg/day is achieved.     

Cardiac event rate after non-Q-wave acute myocardial infarction and the significance of its anterior location

To correlate cardiac event rate with infarct location on the electrocardiogram in patients recovering from a non-Q-wave acute myocardial infarction (AMI), 135 consecutive patients with enzymatically proven non-Q-wave AMI were followed prospectively for a median of 9.9 months. Of these, 65 patients were classified as having had an anterior non-Q-wave AMI, defined as new ST- or T-wave changes, or both, in leads V1 through V4 (group 1). The remaining 70 patients were classified as having had inferior or lateral non-Q-wave AMI, or both, defined as ST- or T-wave changes in 2 consecutive leads (II, II aVF; II and aVL or V5 and V6) (group 2). At baseline group I was older and had a higher incidence of previous AMI than group 2. After adjusting for baseline variables, the patients in group I had a 29% reinfarction and 32% mortality rate, which was significantly higher (p less than 0.002 for both) when compared to group 2, which had a reinfarction and mortality rate of 8 and 9%, respectively. Patients with anterior non-Q-wave AMI are at very high risk for developing a major cardiac event very soon after the index AMI. This high risk is probably related to a larger area of residual ischemic but viable myocardium in the infarct-related artery when compared to inferolateral non-Q-wave AMI.