Home' Trinidad and Tobago Guardian : December 21st 2013 Contents A32
body & soul
Guardian www.guardian.co.tt Saturday, December 21, 2013
CLOSURE OF INSTITUTIONS
The Port-of-Spain Corporation advises members of the public that
the undermentioned institutions will be CLOSED on Wednesday
December 25, 2013 (Christmas Day), Thursday December
26, 2013 (Boxing Day) and Wednesday January 1, 2014
(New Year's Day)
> Central Market
> St. James Market
> Port-of-Spain Abattoir
> Lapeyrouse Cemetery
> Woodbrook/Western Cemeteries
> Port-of-Spain Crematorium
> King George V Tennis Court
Although the offices at the three (3) cemeteries will be closed on the
above-mentioned days, the gates at these facilities will remain open
between the hours 6.00 a.m. to 6.00 p.m.
Chief Executive Officer
Many older adults with high blood pressure can
be treated less aggressively, which could mean taking
fewer pills to get it under control, according to new
treatment guidelines from an expert panel. But not
all experts are on board with the advice---including
the federal agency that appointed the group.
Panel members stressed that they are not changing
the definition of high blood pressure: 140 over 90.
For adults aged 60 and older, they are recommending
a higher treatment threshold, prescribing medicine
only when blood pressure levels reach 150 over 90 or
Too aggressive blood pressure treatment can cause
fainting and falls in older patients, or bad interactions
with drugs they re already taking for other illnesses,
panel members said.
The panel does endorse the lower target of 140 over
90 for younger adults---and for all adults who also
have diabetes or kidney disease.
The guidelines released last Wednesday are based
on a review of the most rigorous kind of medical
research---studies in which patients are randomly pre-
scribed drugs or dummy pills---published since the
last update in 2003. The research suggests older
patients can avoid major health problems like heart
attacks, strokes and kidney disease even when their
blood pressure is above the current recommended
level, the panel said.
For many patients, two or three drugs---or more---
are needed to bring their blood pressure down. Many
older adults could probably reduce their doses, or take
fewer drugs, to reach the new, less strict target, said
Dr Paul James, a panel member and family medicine
specialist-researcher at the University of Iowa.
While the guidelines were updated by a govern-
ment-appointed panel, they don t have the govern-
ment s endorsement like previous versions. The panel
completed its work earlier this year, around the same
time that the National Heart, Lung and Blood Institute
announced that it was getting out of the guidelines
business and turning the job over to the American
Heart Association and American College of Cardiology.
Updated guidelines from those medical groups are
expected in late 2014.
In the meantime, the heart association is raising
concerns about the new recommendations, saying
that many studies they are based on didn t last long
enough to reveal dangers of undertreated high blood
pressure in older patients. The panel also overlooked
other evidence suggesting the 2003 government-
backed recommendations are sound, said Dr Elliott
Antman, the heart association s president-elect. He
noted that his group last month published a treatment
formula that echoes the 2003 advice.
Dr Gary Gibbons, the federal agency s director,
issued a statement Wednesday emphasising that his
agency has not sanctioned the panel s report, nor has
the broader National Institutes of Health. While noting
that the panel decided not to collaborate with the
heart groups efforts, Gibbons said his agency would
work with those groups "to transition" the panel s
evidence review into their update. His statement did
not address whether the agency opposes all the panel s
James said panel members chose to release their
guidelines independently to get the recommendations
out sooner and into the hands of primary care doctors,
who treat large numbers of patients with high blood
pressure. The guidelines were published online
Wednesday in the Journal of the American Medical
Dr Curtis Rimmerman, a Cleveland Clinic cardi-
ologist, called the guidelines "exceedingly important"
given the prevalence of high blood pressure, which
affects about 1 in 3 US adults, or 68 million.
Higher blood pressure
threshold OK in older adults
Whether many doctors immediately adopt the advice
"remains to be seen," he said. Rimmerman predicted that
some will continue to push to get older patients blood
pressure lower than the new recommendation, especially
those with previous strokes or heart problems.
The panel said their guidelines are simply recommen-
dations, and that doctors should make treatment decisions
based on patients individual circumstances. The experts
emphasised that everyone with high blood pressure can
benefit from a healthy diet, regular exercise and weight
control, which all can help lower blood pressure.
YOUR DAILY HEALTH
News and advice
Many older adults with high blood pressure can be treated less aggressively,
which could mean taking fewer pills to get it under control.
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