Category Archives: Neurology

The mechanisms by which hypertension causes vascular events are unclear. Guidelines for diagnosis and treatment focus only on underlying mean blood pressure.

In each TIA cohort in this study, visit-to-visit variability in systolic blood pressure (SBP) was a strong predictor of subsequent stroke (eg, top-decile hazard ratio [HR] for SBP 6·22), independent of mean SBP.

Maximum SBP reached was also a strong predictor of stroke (HR 15).

Visit-to-visit variability in SBP on treatment was also a strong predictor of stroke and coronary events (top-decile HR for stroke: 3·25) independent of mean SBP.

Visit-to-visit variability in SBP and maximum SBP are strong predictors of stroke, independent of mean SBP. Increased residual variability in SBP in patients with treated hypertension is associated with a high risk of vascular events.

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Drinkers of 15 or more units per week in any BMI category and obese drinkers had raised relative rates for all definitions of liver disease, compared with underweight/normal weight non-drinkers.

The relative excess risk due to interaction between BMI and alcohol consumption was 5.58.

Raised BMI and alcohol consumption are both related to liver disease, with evidence of a supra-additive interaction between the two.

The occurrence of both factors in the same populations should inform health promotion and public health policies.

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From The Lancet theme issue on diabetes:

Almost half of England's football managers have "significant" heart problems and their life-consuming, high-pressure jobs are a "recipe for potential disaster" according to cardiovascular experts. This is hardly surprising considering the range of emotions demonstrated by Fabio Capello (age 64), the current manager of the England national football team, in the video below:

A stressful soccer match affects everybody involved including the spectators.

The Fédération Internationale de Football Association (FIFA) World Cup, held in Germany from June 9 to July 9, 2006, provided an opportunity to examine the relation between emotional stress and the incidence of cardiovascular events. Cardiovascular events occurring in 4,000 patients in the greater Munich area were prospectively assessed by emergency physicians during the World Cup.

On days of matches involving the German team, the incidence of cardiac emergencies was 2.66 times that during the control period. For men, the incidence was 3.26 times that during the control period, and for women, it was 1.82 times that during the control period.

On those days, the highest average incidence of events was observed during the first 2 hours after the beginning of each match.

Viewing a stressful soccer match more than doubles the risk of an acute cardiovascular event. In view of this excess risk, particularly in men with known coronary heart disease, preventive measures are urgently needed.

References:
Nearly half of football managers suffer serious heart problems. Independent, 2005.
Cardiovascular events during World Cup soccer. N Engl J Med. 2008 Jan 31;358(5):475-83.

Childhood absence epilepsy, the most common pediatric epilepsy syndrome, is usually treated with ethosuximide, valproic acid, or lamotrigine.

Ethosuximide and valproic acid are more effective than lamotrigine in the treatment of childhood absence epilepsy. Ethosuximide is associated with fewer adverse attentional effects.

References:
Ethosuximide, Valproic Acid, and Lamotrigine in Childhood Absence Epilepsy. NEJM, 2010.

Both dopamine and norepinephrine (Levophed) are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other.

Although there was no significant difference in the rate of death between patients with shock who were treated with dopamine as the first-line vasopressor agent and those who were treated with norepinephrine, the use of dopamine was associated with a greater number of adverse events.

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