AHA re-defines high BP in its new guidelines:

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New guidelines from the American Heart Association AHA and the American College of Cardiology ACC for detection prevention management and treatment of high blood pressure have redefined high blood pressure for first time in 14 years. The guidelines were presented November 13 2017 at AHA s 2017 Scientific Sessions conference in Anaheim In a change from the older definition of 140 90 and higher high BP is now defined as systolic BP 130 mm Hg and higher or diastolic BP 80 and higher. By lowering the definition of high BP the guidelines recommend earlier intervention to prevent further increases in blood pressure and the complications of hypertension. The importance of using proper technique to measure BP has been emphasized. Blood pressure levels should be based on an average of two to three readings on at least two different occasions. The new guidelines have eliminated the category of prehypertension which was used for blood pressures with a top number systolic between 120 139 mm Hg or a bottom number diastolic between 80 89 mm Hg. People with those readings now will be categorized as having either Elevated 120 129 and less than 80 or Stage I hypertension 130 139 or 80 89 . Previous guidelines classified 140 90 mm Hg as Stage 1 hypertension. This level is classified as Stage 2 hypertension under the new guidelines. High blood pressure should be treated earlier with lifestyle changes and in some patients with medication at 130 80 mm Hg rather than 140 90. Medication for Stage I hypertension should be prescribed if a patient has already had a cardiovascular event such as a heart attack or stroke or is at high risk of heart attack or stroke based on age the presence of diabetes mellitus chronic kidney disease or calculation of atherosclerotic risk. Blood pressure categories in the new guideline are Normal Less than 120 80 mm Hg Elevated Top number systolic between 120 129 and bottom number diastolic less than 80 Stage 1 Systolic between 130 139 or diastolic between 80 89 Stage 2 Systolic at least 140 or diastolic at least 90 mm Hg Hypertensive crisis Top number over 180 and or bottom number over 120 with patients needing prompt changes in medication if there are no other indications of problems or immediate hospitalization if there are signs of organ damage. Source AHA News Release November 13 2017

Sugar-sweetened drinks increase risk of diabetes and metabolic syndrome

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A review of epidemiological studies published online November 2 2017 in the Journal of the Endocrine Society has added to the growing evidence of the association of sugar sweetened beverages with chronic lifestyle disorders such as type 2 diabetes hypertension and heart disease. The review which examined the association of sugar sweetened beverages with type 2 diabetes metabolic syndrome and hypertension found that regularly drinking sugar sweetened beverages such as soda and juice contributes to the development of type 2 diabetes and high blood pressure. Most of the studies included in the review found that consumption of sugar sweetened beverages also increased the risk of metabolic syndrome which in turn increased the risk of developing heart disease stroke and diabetes. The review included 36 studies on the cardiometabolic effects of sugar sweetened beverage consumption from the last 10 years. Most of the analyzed studies for metabolic syndrome included individuals who drank more than five sugar sweetened beverages a week while consuming as few as two servings of sugar sweetened beverages a week increased the risk of developing type 2 diabetes. Drinking at least one sugar sweetened beverage a day was associated with high blood pressure. These findings yet again highlight the need to educate the general public the young in particular about the adverse health effects of sugar sweetened beverages who frequently consume foods and drinks high in added sugars. It is very important therefore to raise awareness among the public about the lifestyle diseases prevalent in our country which are now occurring at a younger age and the lifestyle measure by which these disease can be prevented. Source Endocrine Society News Release November 2 2017

New guidelines on diabetes self-management education and support

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Management of diabetes is multidisciplinary and a team approach is the basis of care of the patient with diabetes, who is at the center of this team.

Diabetes self-management education (DSME) is a very important aspect of management in all patients with diabetes, including those with prediabetes. Optimal control of blood sugar is important; but, it is also important to control other risk factors such as hypertension, dyslipidemia in order to prevent the macrovascular and microvascular complications of diabetes. Because of the need for lifestyle modifications, patients with diabetes are themselves responsible for the day to day management of diabetes, but with the support of the doctor.

For the first time, the American Diabetes Association (ADA) and American Association of Diabetes Educators (AADE) have combined education and support (DSMES) and released new standards to help diabetes educators and medical providers establish and sustain patient care models, programs and teams for people with diabetes and their caregivers. These guidelines will be published in the September 2017 issues of Diabetes Care and The Diabetes Educator.

These standards relate to organizational structure, participation of community stakeholders, access, program coordination, instructional staff, individualizing diabetes education to the need of each patient, monitoring of patient progress and quality improvement. An up-to-date, evidence-based, and flexible curriculum provides education.

These standards emphasize that DSME alone does not translate into effective self care. Ongoing support is very important to improve patient outcomes.

The standards defined in these recommendations can be applied to both small solo practices, as well as large, multicenter facilities.

(ADA Press Release, July 28, 2017)
Dr KK Aggarwal
National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award
Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)
Past Honorary Secretary General IMA
Past Senior National Vice President IMA
President Heart Care Foundation of India
Gold Medalist Nagpur University
Limca Book of Record Holder in CPR 10
Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS
Member Ethics Committee Medical Council of India (2013-14)
Chairman Ethics Committee Delhi Medical Council (2009-15)
Elected Member Delhi Medical Council (2004-2009)
Chairman IMSA Delhi Chapter (March 10- March 13)
Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)

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