This week in the BMJ

Volume 332, Number 7542, Issue of 18 Mar 2006

[Down]Blood pressure drop in MONICA populations is not from use of antihypertensives
[Down]Energy supplements may not be necessary for children with cystic fibrosis
[Down]Guidelines on blood pressure after stroke may not apply to primary care
[Down]Longer needles needed for gluteal intramuscular injections
[Down]What works for osteoarthritis?

Blood pressure drop in MONICA populations is not from use of antihypertensives

The declining blood pressures seen in many industrialised countries are not attributable to use of antihypertensive drugs. Tunstall-Pedoe and colleagues (p 629) pooled the results from the MONICA project (which monitored cardiovascular disease in 38 populations in 21 industrialised countries from the mid-1980s to the mid-1990s) to examine patterns in the blood pressure declines that had been reported in most populations. The changes in blood pressure were not due to declines in high readings only, which would be attributable to better hypertension control in that group; instead, blood pressure fell similarly in groups with low, middle, and high blood pressure.


Figure 1
 Credit: SHEILA TERRY/SPL

 



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Energy supplements may not be necessary for children with cystic fibrosis

When children with cystic fibrosis and suboptimal nutrition receive regular dietary advice, providing oral protein energy supplements confers no additional improvement in nutritional status. In a multicentre randomised trial of more than 100 moderately malnourished children aged 2-15 years with cystic fibrosis, Poustie and colleagues (p 632) found no difference in mean change in body mass index centile or other nutritional and spirometric outcomes from baseline to 12 months between the children who received dietary advice plus dietary supplements and those who received only advice.


Figure 1
 Credit: SIMON FRASER/SPL

 



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Guidelines on blood pressure after stroke may not apply to primary care

Typical primary care patients with cerebrovascular disease have very different characteristics than those of participants in the PROGRESS trial, on which national guidelines for blood pressure lowering are based. In a cross sectional survey, Mant and colleagues (p 635) looked at characteristics of more than 500 representative primary care patients with confirmed stroke or transient ischaemic attack. They found important differences in age, sex, time since last cerebrovascular event, blood pressure, and use of antihypertensive drugs between their patient group and PROGRESS participants.


Figure 1
 Credit: JUSTINE DESMOND/WELLCOME PHOTO LIBRARY

 



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Longer needles needed for gluteal intramuscular injections

Because of increasing obesity, gluteal muscles may be beyond the reach of standard green and blue needles in many patients. In a retrospective study, Nisbet (p 637) examined gluteal intramuscular injection sites of 100 consecutive patients who had had computed tomography of the pelvis. He found that muscle depth was greater than the maximum reach of a green needle (35 mm) at the ventrogluteal and dorsogluteal sites in 12 and 43 patients respectively. In 26 and 72 patients the site depths were more than 25 mm (extent of a blue needle). Nisbet recommends that intramuscular gluteal injections should be avoided for most drugs or longer needles should be used.


Figure 1
 



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What works for osteoarthritis?

In order to control pain, improve function, and alter the disease process, patients with osteoarthritis should be managed with a combination of methods, say Hunter and Felson on page 639. Non-pharmacological management such as weight loss, physical therapy, and knee braces should be tried before drug treatment, and surgery should be considered only when effective medical treatment has failed. The authors review diagnosis and investigation and summarise current knowledge about epidemiology and management of this common joint disease.



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