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Do Far-infrared Saunas Have Cardiovascular Benefits in People with Type 2 Diabetes?
Abstract
Objective: Far-infrared saunas are beneficial for the treatment of congestive heart failure, hypertension and obesity. As such, they may have a beneficial effect on cardiovascular (CV) health in those with type 2 diabetes. Our objective is to examine whether or not there are quantitative CV benefits from infrared sauna use. Methods: The intervention consisted of 20-minute, thriceweekly infrared sauna sessions, over a period of 3 months. The following CV risk factors were measured: weight, height, waist circumference, blood pressure (BPtru), glycated hemoglobin (A1C), fasting blood glucose and cholesterol profile. Baseline study parameters were measured within one week prior to commencing sauna sessions. Post-intervention measurements were collected between 1 and 3 days after the last sauna session. Results: Systolic blood pressure decreased by 6.4 mm Hg (124±12 vs. 118±15 mm Hg, 95% CI 0.01-12.71 p=0.05), and there was a trend toward decreased waist circumference (115.0±13.4 vs. 112.7±11.9 cm, 95% CI 0.4-5.1 p=0.10). All other measurements did not change significantly. There were no adverse events. Study completion rate was 75%. Conclusion: Our results suggest that infrared sauna use may be beneficial for lowering blood pressure and waist circumference. Subject adherence to infrared sauna use is greater than adherence to other lifestyle interventions. The combination of favourable compliance/adherence, as well as effectiveness in improving blood pressure and possibly waist circumference, makes infrared sauna therapy an attractive lifestyle option.
... Conflicting evidence, however, exists for plasma [insulin] where it improves in healthy overweight individuals (9-11) but not in women with PCOS (13). To date, there have been five studies (17,(35)(36)(37)(38) investigating passive heating in T2DM. However, with exception to Hooper (17), none of these studied body temperature (35)(36)(37)(38), and given their methodologies, their thermal doses were likely either too short (35)(36)(37)(38) or too mild (35,37,38) (or both) to create significant heat stress and cause any responses or beneficial adaptations from heat acclimation. ...
... To date, there have been five studies (17,(35)(36)(37)(38) investigating passive heating in T2DM. However, with exception to Hooper (17), none of these studied body temperature (35)(36)(37)(38), and given their methodologies, their thermal doses were likely either too short (35)(36)(37)(38) or too mild (35,37,38) (or both) to create significant heat stress and cause any responses or beneficial adaptations from heat acclimation. ...
... To date, there have been five studies (17,(35)(36)(37)(38) investigating passive heating in T2DM. However, with exception to Hooper (17), none of these studied body temperature (35)(36)(37)(38), and given their methodologies, their thermal doses were likely either too short (35)(36)(37)(38) or too mild (35,37,38) (or both) to create significant heat stress and cause any responses or beneficial adaptations from heat acclimation. ...
Objectives: Repeated hot water immersion (HWI) can improve glycaemic control in healthy individuals, but data are limited for individuals with T2DM. The present study investigated whether repeated HWI improves insulin sensitivity, inflammatory status, reduces plasma ([extracellular heat shock protein 70]) [eHSP70] and resting metabolic rate (RMR). Materials and methods: Fourteen individuals with T2DM participated in this pre- vs. post-intervention study, with outcome measures assessed in fasted (≥ 12 h) and post-prandial (2 hr post-75 g glucose ingestion) states. HWI consisted of 1 h in 40°C water (target rectal temperature 38.5 - 39°C) repeated 8-10 times within a 14-day period. Outcome measures included: insulin sensitivity, plasma [glucose], [insulin], [eHSP70], inflammatory markers, RMR and substrate utilisation. Results: The HWI intervention increased fasted insulin sensitivity ( p = 0.03) and lowered fasted plasma [insulin] ( p = 0.04), but fasting plasma [glucose] ( p = 0.83), [eHSP70] ( p = 0.08), [IL-6] ( p = 0.55), [IL-10] ( p = 0.59), post-prandial insulin sensitivity ( p = 0.19), plasma [glucose] ( p = 0.40) and [insulin] ( p = 0.47) were not different. RMR reduced ( p < 0.05), although carbohydrate ( p = 0.43) and fat oxidation ( p = 0.99) rates were unchanged. Conclusion: This study shows that 8-10 HWIs within a 14-day period improved fasting insulin sensitivity and plasma [insulin] in individuals with T2DM, but not when glucose tolerance is challenged. HWI also improves metabolic efficiency (i.e. reduced RMR). Together, these results could be clinically important and have implications for metabolic health outcomes and well-being in individuals with T2DM.
... The results of our systematic search and selection detailed on a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flowchart can be seen in Figure 1. The systematic search yielded 5 [24][25][26][27][28] eligible articles for the qualitative and quantitative analysis, including the data of 193 patients. ...
... Three out of the five included [24][25][26] articles reported on other laboratory parameters and the changes in the body weight, blood pressure, and heart rate, pre-, and post-intervention. We summarized these parameters in Table 2. Based on the paper of Koc¸ak et al. [26] we can observe that HOMA-IR, leptin-, visfatin, and cortisol levels showed a slight decrease after the intervention, while the insulin, CRP, adiponectin levels and ESR increased compared to pre-intervention measures. ...
... We summarized these parameters in Table 2. Based on the paper of Koc¸ak et al. [26] we can observe that HOMA-IR, leptin-, visfatin, and cortisol levels showed a slight decrease after the intervention, while the insulin, CRP, adiponectin levels and ESR increased compared to pre-intervention measures. Beever et al. [24] reported a decreased systolic blood pressure and heart rate. Two articles [24,25] measured changes in body weight in the follow-up period; the mean body weight showed a mild decrease in one of the studies [25] but increased in the other one [24] compared pre-and postinterventions weight and BMI. ...
Aims
Type-2 diabetes mellitus (T2DM) is a common health condition which prevalence increases with age. Besides lifestyle modifications, passive heating could be a promising intervention to improve glycemic control. This study aimed to assess the efficacy of passive heat therapy on glycemic and cardiovascular parameters, and body weight among patients with T2DM.
Methods
A systematic review and meta-analysis were reported according to PRISMA Statement. We conducted a systematic search in three databases (MEDLINE, Embase, CENTRAL) from inception to 19 August 2021. We included interventional studies reporting on T2DM patients treated with heat therapy. The main outcomes were the changes in pre-and post-treatment cardiometabolic parameters (fasting plasma glucose, glycated plasma hemoglobin, and triglyceride). For these continuous variables, weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated. Study protocol number: CRD42020221500.
Results
Five studies were included in the qualitative and quantitative synthesis, respectively. The results showed a not significant difference in the hemoglobin A1c [WMD −0.549%, 95% CI (−1.262, 0.164), p = 0.131], fasting glucose [WMD −0.290 mmol/l, 95% CI (−0.903, 0.324), p = 0.355]. Triglyceride [WMD 0.035 mmol/l, 95% CI (−0.130, 0.200), p = 0.677] levels were comparable regarding the pre-, and post intervention values.
Conclusion
Passive heating can be beneficial for patients with T2DM since the slight improvement in certain cardiometabolic parameters support that. However, further randomized controlled trials with longer intervention and follow-up periods are needed to confirm the beneficial effect of passive heat therapy.
... The use of hot water therapy in individuals with diabetes began with a 1999 study demonstrating that 3 wk of half-an-hour hot tub sessions 6 d·wk −1 in patients with T2DM reduces fasting blood glucose levels by 23 mg·dL −1 and HbA 1c by 1% (53). Because Hooper et al. performed this study, other groups have similarly demonstrated that heat treatment reduces fasting blood glucose (65) and HbA 1c (66), and that it also favorably modifies other markers of metabolic health in patients with T2DM (65,67). Koçak et al. (65) demonstrated that in addition to the beneficial effects on glucose control, 20 min of heat therapy five times per week for 3 wk increases adiponectin and high-density lipoprotein, while reducing leptin, vasfatin, and low-density lipoprotein in obese women with T2DM. ...
... Koçak et al. (65) demonstrated that in addition to the beneficial effects on glucose control, 20 min of heat therapy five times per week for 3 wk increases adiponectin and high-density lipoprotein, while reducing leptin, vasfatin, and low-density lipoprotein in obese women with T2DM. Furthermore, Beever (67) showed that 20 min of heat therapy three times a week for 3 months reduces systolic blood pressure in patients with T2DM. ...
This review proposes the novel hypothesis that heat can be used as an alternative therapy to exercise to improve hepatic mitochondrial function and glucose regulation in patients with non-alcoholic fatty liver disease (NAFLD). Although exercise has proven benefits in treating NAFLD, barriers to exercise in the majority of patients necessitate an alternative method of treatment.
... 11 Indeed, externally applied IR-C light has demonstrated positive therapeutic effects in tissues at considerable depth that very little residual radiant energy could reach (e.g., brain, cardiovascular system, musculoskeletal system). 33,42,43,44,45 The overall positive effect of the photobiomodulation initiated by IR-C radiation indicates that there might be a "companion" energy transfer pathway involved. ...
Background:
Up to 33% of the general population worldwide suffer musculoskeletal conditions, with low back pain being the single leading cause of disability globally. Multimodal therapeutic options are available to relieve the pain associated with muscular disorders, including physical, complementary and pharmacological therapies. However, existing interventions are not disease-modifying and have several limitations.
Method:
Literature review.
Results:
In this context, the use of non-thermal infrared light delivered via patches, fabrics, and garments containing infrared-emitting bioceramic minerals have been investigated. Positive effects on muscular cells, muscular recovery, reduced inflammation and pain, have been reported both in pre-clinical and clinical studies. There are several hypotheses on how infrared may contribute to musculoskeletal pain relief, however, the full mechanism of action remains unclear. This article provides an overview of the physical characteristics of infrared radiation and its biological effects, focusing on those that could potentially explain the mechanism of action responsible for the relief of musculoskeletal pain.
Conclusions:
Based on the current evidence, the following pathways have been considered: up-regulation of endothelial nitric oxide synthase, increase in nitric oxide bioavailability, anti-inflammatory effects and reduction in oxidative stress.
... As being one of such usage areas, saunas have been developed, benefiting from treatment features of far infrared radiation [3]. It has been reported that these saunas are used in the treatments of congestive coronary failure, hypertension and obesity [4]. The positive effects of far infrared radiation have also taken the attention of textile engineers and interest in textile designs with these features has increased in recent years. ...
Infrared radiation refers to electromagnetic radiation whose wavelength is longer than visible light, but shorter than terahertz and microwave radiation. Far infrared radiation (FIR) denotes radiation that is considered a kind of infrared radiation and includes wavelengths between 5.6-1000 micron. These rays are emitted by sun rays, human body, metals and some minerals. The positive effect of these rays on human health has already been mentioned and they are widely used especially in Far East countries in textile products and saunas. For the textile products to emit such rays, the fibres or fabrics are required to gain some features. For this purpose, bioseramic powder is applied to the fibres and hence the textile becomes able to emit far infrared rays. This study deals with yarns that have acquired the ability to emit far infrared rays and their usage areas in textile. This review examines bioceramic powders, black body, production of FIR emitting yarns, features of yarns, various usage areas and future trends by means of literature review method.
... There are many researchers studying the effectiveness of FIR therapy in medical field. Richard [2] had carried out the experiment and found that that far-infrared sauna maybe beneficial for lowering blood pressure and waist circumference. Medical uses of infrared radiation range from the simple heat lamp to the technique of thermal imaging, or thermography [3] . ...
α-Cordierite glass ceramic was synthesised through crystallization of glass compacts made of milled glass frits. The effect of temperatures and colorants were studied. The crystal structure of α-cordierite was analysed using X-ray diffraction technique and Rietveld structural refinement method. Density, porosity and shrinkage analysis, Vickers hardness and SEM were also performed. The result revealed that at higher sintering temperatures, the properties of α-cordierite was getting better. Low apparent porosity level and high hardness dense α-cordierite was fabricated at temperature 1350oC. The low porosity level may lead to high thermal conductivity which suggested that cordierite was candidates for FIR therapy instrumemts.________________________________________________________________________
Far-infrared radiation therapies are becoming more popular for blood circulation disorders, cardiovascular disease, skin diseases, inhibit cancer cell, etc replacing conventional operations. In this research, thermal characteristics of heating part in panel radiators, which is effective on the blood circulation disorders were experimentally analyzed. The heating line supplies heat energy to insulation coatings with heat flux of 150mW/m^2 in normal status and as a result the coatings reached 20% of the heating line temperature. In other words, the insulation itself could increase surface temperature of heating plates by 20% and raise thermal time constant promote blood circulation effect. We also found that space arrangement of the heating lines was an important factor in designing heating parts and both coefficient of heat conduction and density of the heating plate should be also considered for superimpose of thermal diffusion.
This present work is an attempt to study the composite between natural rubber (NR) and Macca charcoal, as a special additive, for producing the adhesive plaster for pain relief. The NR latex used in this work was a saponified NR (SPNR) cured by peroxide to avoid allergenic problems in human use, which causes by protein and accelerator in sulphur cure. Macca charcoal is proved to have ability to generate far infrared rays (FIR) in the range of 6-14 µm which can transfer to be heat energy. The human body can absorb FIR in this range because of their deep penetrating ability. Light energy is changed to thermal energy when FIR penetrates through skin to the subcutaneous tissues. This thermal energy helps to decrease the symptoms of stress and fatigue such as headaches, joint pain, burns, muscle spasms, and insomnia. In this work, the SPNR/Macca composite was subjected to studying the effect of Macca charcoal content on the physical and thermal properties of SPNR composites. The results showed that hardness and tensile properties increased with increasing an addition of Macca charcoal in SPNR. In addition, the increasing of Macca charcoal content enhance thermal retention estimation and thermal intensity, but has no substantial effect on depth of FIR diffusion on pork layer. Thus, SPNR/Macca charcoal composites can be an optional material apply for an adhesive bandage for pain relief purpose.
Obesity is now so common within the world's population that it is beginning to replace undernutrition and infectious diseases as the most significant contributor to ill health. In particular, obesity is associated with diabetes mellitus, coronary heart disease, certain forms of cancer, and sleep-breathing disorders. Obesity is defined by a body-mass index (weight divided by square of the height) of 30 kg m(-2) or greater, but this does not take into account the morbidity and mortality associated with more modest degrees of overweight, nor the detrimental effect of intra-abdominal fat. The global epidemic of obesity results from a combination of genetic susceptibility, increased availability of high-energy foods and decreased requirement for physical activity in modern society. Obesity should no longer be regarded simply as a cosmetic problem affecting certain individuals, but an epidemic that threatens global well being.
Although sauna bathing causes various acute, transient cardiovascular and hormonal changes, it is well tolerated by most healthy adults and children. Sauna bathing does not influence fertility and is safe during the uncomplicated pregnancies of healthy women. Some studies have suggested that long-term sauna bathing may help lower blood pressure in patients with hypertension and improve the left ventricular ejection fraction in patients with chronic congestive heart failure, but additional data are needed to confirm these findings. The transient improvements in pulmonary function that occur in the sauna may provide some relief to patients with asthma and chronic bronchitis. Sauna bathing may also alleviate pain and improve joint mobility in patients with rheumatic disease. Although sauna bathing does not cause drying of the skin-and may even benefit patients with psoriasis-sweating may increase itching in patients with atopic dermatitis. Contraindications to sauna bathing include unstable angina pectoris, recent myocardial infarction, and severe aortic stenosis. Sauna bathing is safe, however, for most people with coronary heart disease with stable angina pectoris or old myocardial infarction. Very few acute myocardial infarctions and sudden deaths occur in saunas, but alcohol consumption during sauna bathing increases the risk of hypotension, arrhythmia, and sudden death, and should be avoided.
Cardiovascular morbidity is a major burden in patients with type 2 diabetes. In the Steno-2 Study, we compared the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment on modifiable risk factors for cardiovascular disease in patients with type 2 diabetes and microalbuminuria.
The primary end point of this open, parallel trial was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, revascularization, and amputation. Eighty patients were randomly assigned to receive conventional treatment in accordance with national guidelines and 80 to receive intensive treatment, with a stepwise implementation of behavior modification and pharmacologic therapy that targeted hyperglycemia, hypertension, dyslipidemia, and microalbuminuria, along with secondary prevention of cardiovascular disease with aspirin.
The mean age of the patients was 55.1 years, and the mean follow-up was 7.8 years. The decline in glycosylated hemoglobin values, systolic and diastolic blood pressure, serum cholesterol and triglyceride levels measured after an overnight fast, and urinary albumin excretion rate were all significantly greater in the intensive-therapy group than in the conventional-therapy group. Patients receiving intensive therapy also had a significantly lower risk of cardiovascular disease (hazard ratio, 0.47; 95 percent confidence interval, 0.24 to 0.73), nephropathy (hazard ratio, 0.39; 95 percent confidence interval, 0.17 to 0.87), retinopathy (hazard ratio, 0.42; 95 percent confidence interval, 0.21 to 0.86), and autonomic neuropathy (hazard ratio, 0.37; 95 percent confidence interval, 0.18 to 0.79).
A target-driven, long-term, intensified intervention aimed at multiple risk factors in patients with type 2 diabetes and microalbuminuria reduces the risk of cardiovascular and microvascular events by about 50 percent.
Hypertension in patients with type 2 diabetes mellitus is a prevalent condition that leads to substantial morbidity and mortality.
To evaluate the goals and optimal agents for treatment of hypertension in type 2 diabetes.
Review of the medical literature
Randomized trials that evaluated the pharmacologic treatment of hypertension in patients with diabetes and reported microvascular and macrovascular outcomes.
Studies were identified by using the Cochrane Library, MEDLINE, meta-analyses, review articles, and expert recommendation. The searches of the Cochrane Library and MEDLINE were performed in May 2000 and updated in April 2002. Data were abstracted to standardized forms by a single reviewer and were confirmed by a second reviewer.
Treatment of hypertension in type 2 diabetes provides dramatic benefit. Target diastolic blood pressures of less than 80 mm Hg appear optimal; systolic targets have not been as rigorously evaluated, but targets of 135 mm Hg or less are reasonable. Studies that compare drug classes do not suggest obviously superior agents. However, it is reasonable to conclude that thiazide diuretics, angiotensin-II receptor blockers, and perhaps angiotensin-converting enzyme (ACE) inhibitors may be the preferred first-line agents for treatment of hypertension in diabetes. beta-Blockers and calcium-channel blockers are more effective than placebo, but they may not be as effective as diuretics, angiotensin-II receptor blockers, or ACE inhibitors; however, study results are inconsistent in this regard.
Treatment of hypertension in type 2 diabetes, with blood pressure goals of 135/80 mm Hg, provides dramatic benefits. Thiazide diuretics, angiotensin II receptor blockers, and ACE inhibitors may be the best first-line treatments, although other agents are usually necessary and goals may not be achieved even with three or four agents. Aggressive blood pressure control may be the most important factor in preventing adverse outcomes in patients with type 2 diabetes.
Systemic thermal therapy, such as taking a warm-water bath and sauna, induces systemic vasodilation. It was found that repeated sauna therapy (60 degrees C for 15 min) improved hemodynamic parameters, clinical symptoms, cardiac function, and vascular endothelial function in patients with congestive heart failure. Vascular endothelial function is impaired in subjects with lifestyle-related diseases, such as hypertension, hyperlipidemia, diabetes mellitus, obesity, and smoking. Sauna therapy also improved endothelial dysfunction in these subjects, suggesting a preventive role for atherosclerosis. In animal experiments, sauna therapy increases mRNA and protein levels of endothelial nitric oxide synthase (eNOS) in aortas. In normal-weight patients with appetite loss, repeated sauna therapy increased plasma ghrelin concentrations and daily caloric intake and improved feeding behavior. In obese patients, the body weight and body fat significantly decreased after 2 weeks of sauna therapy without increase of plasma ghrelin concentrations. On the basis of these data, sauna therapy may be a promising therapy for patients with lifestyle-related diseases.
We have reported that repeated sauna therapy improves impaired vascular endothelial function in a patient with coronary risk factors. We hypothesized that sauna therapy decreases urinary 8-epi-prostaglandin F(2alpha) (PGF(2alpha)) levels as a marker of oxidative stress and conducted a randomized, controlled study. Twenty-eight patients with at least one coronary risk factor were divided into a sauna group (n = 14) and non-sauna group (n = 14). Sauna therapy was performed with a 60 degrees C far infrared-ray dry sauna for 15 minutes and then bed rest with a blanket for 30 minutes once a day for two weeks. Systolic blood pressure and increased urinary 8-epi-PGF(2alpha) levels in the sauna group were significantly lower than those in the non-sauna group at two weeks after admission (110 +/- 15 mmHg vs 122 +/- 13 mmHg, P < 0.05, 230 +/- 67 pg/mg x creatinine vs 380 +/- 101 pg/mg x creatinine, P < 0.0001, respectively). These results suggest that repeated sauna therapy may protect against oxidative stress, which leads to the prevention of atherosclerosis.
To determine practices and perceptions of family physicians regarding lifestyle interventions to prevent and manage type 2 diabetes (T2D).
Confidential mailed survey.
Canadian family practices.
Random, stratified sample of 1499 respondents to the 2001 National Family Physician Workforce Survey.
Physicians' self-reported practice patterns and perceptions of lifestyle counseling for patients at risk for, and diagnosed with, T2D.
Response rate was 53% (749/1410). Respondents frequently asked patients at risk for, or diagnosed with, T2D about physical activity and weight loss, but far fewer provided written advice, particularly about physical activity. Respondents thought counseling with such interventions as generic patient handouts was preferable to more intensive lifestyle management strategies, such as appointments to provide stage-matched counseling on physical activity. Most respondents thought family physicians should perform lifestyle interventions but realized they are confounded by such barriers as patients' lack of interest and limited referral resources.
Family physicians keen to implement lifestyle interventions for T2D are hampered by barriers and use of ineffective strategies.
The aim of the present study was to determine whether repeated 60 degrees C sauna treatment improves cardiac arrhythmias in chronic heart failure (CHF) patients, because ventricular arrhythmias are an important therapeutic target in CHF.
Thirty patients (59+/-3 years) with New York Heart Association functional class II or III CHF and at least 200 premature ventricular contractions (PVCs)/24 h assessed by 24-h Holter recordings were studied. They were randomized into sauna-treated (n=20) or non-treated (n=10) groups. The sauna-treated group underwent a 2-week program of a daily 60 degrees C far infrared-ray dry sauna for 15 min, followed by 30 min bed rest with blankets, for 5 days per week. Patients in the non-treated group had bed rest in a temperature-controlled room (24 degrees C) for 45 min. The total numbers of PVCs/24 h in the sauna-treated group decreased compared with the non-treated group [848+/-415 vs 3,097+/-1,033/24 h, p<0.01]. Heart rate variability (SDNN, standard deviation of normal-to-normal beat interval) increased [142+/-10 (n=16) vs 112+/-11 ms (n=8), p<0.05] and plasma brain natriuretic peptide concentrations decreased [229+/-54 vs 419+/-110 pg/ml, p<0.05] in the sauna-treated group compared with the non-treated group.
Repeated sauna treatment improves ventricular arrhythmias in patients with CHF.
Background
Increasing evidence suggests that ABPM more closely predicts target organ damage than does clinic measurement. Future guidelines may suggest ABPM as routine in the diagnosis and monitoring of hypertension. This would create difficulties as this test is expensive and often difficult to obtain. The purpose of this study is to determine the degree to which the BpTRU automatic blood pressure monitor predicts results on 24 hour ambulatory blood pressure monitoring (ABPM).
Methods
A quantitative analysis comparing blood pressure measured by the BpTRU device with the mean daytime blood pressure on 24 hour ABPM. The study was conducted by the Centre for Studies in Primary Care, Queen's University, Kingston, Ontario, Canada on adult primary care patients who are enrolled in two randomized controlled trials on hypertension. The main outcomes were the mean of the blood pressures measured at the three most recent office visits, the initial measurement on the BpTRU-100, the mean of the five measurements on the BpTRU monitor, and the daytime average on 24 hour ABPM.
Results
The group mean of the three charted clinic measured blood pressures (150.8 (SD10.26) / 82.9 (SD 8.44)) was not statistically different from the group mean of the initial reading on BpTRU (150.0 (SD21.33) / 83.3 (SD12.00)). The group mean of the average of five BpTRU readings (140.0 (SD17.71) / 79.8 (SD 10.46)) was not statistically different from the 24 hour daytime mean on ABPM (141.5 (SD 13.25) / 79.7 (SD 7.79)). Within patients, BpTRU average correlated significantly better with daytime ambulatory pressure than did clinic averages (BpTRU r = 0.571, clinic r = 0.145). Based on assessment of sensitivity and specificity at different cut-points, it is suggested that the initial treatment target using the BpTRU be set at <135/85 mmHG, but achievement of target should be confirmed using 24 hour ABPM.
Conclusion
The BpTRU average better predicts ABPM than does the average of the blood pressures recorded on the patient chart from the three most recent visits. The BpTRU automatic clinic blood pressure monitor should be used as an adjunct to ABPM to effectively diagnose and monitor hypertension.
OBJECTIVE—To assess the relation between fasting plasma glucose (FPG) or 2-h plasma glucose (2hPG) and mortality from all causes, cardiovascular disease (CVD), and non-CVD and to determine whether the relationship is graded or threshold.
RESEARCH DESIGN AND METHODS—Diabetes Epidemiology: Collaborative Analysis Of Diagnostic Criteria in Europe (DECODE) is a collaborative prospective study of 22 cohorts in Europe with baseline glucose measurements for 29,714 subjects aged 30–89 years who were followed-up for 11 years (329,050 person-years). Hazard ratio (HR) for death was estimated using Cox regression analysis.
RESULTS—High glucose concentrations as well as very low glucose levels were associated with increased risk of death. Compared with an FPG of 4.50–6.09 mmol/l, the multivariate-adjusted HR (95% CI) for FPG <4.50 mmol/l was 1.2 (1.0–1.4) for all-cause, 1.3 (1.0–1.8) for CVD, and 1.1 (0.9–1.4) for non-CVD mortality; the corresponding HRs for diabetes (FPG ≥7.0 mmol/l) were 1.6 (1.4–1.8), 1.6 (1.3–1.9), and 1.6 (1.4–1.9), respectively. For a 2hPG of 3.01–4.50 mmol/l, as compared with a 2hPG of 4.51–5.50 mmol/l, the HRs were 1.1 (1.0–1.2), 1.1 (0.9–1.3), and 1.1 (1.0–1.3), respectively; the corresponding HRs for diabetes (2hPG ≥11.1 mmol/l) were 2.0 (1.7–2.3), 1.9 (1.5–2.4), and 2.1 (1.7–2.5), respectively. The HR for previously undetected diabetes defined by 2hPG was not significantly different from that for known diabetes, which was significantly higher than that for undetected diabetes based on FPG. Subjects with a 2hPG of 10.01–11.09 mmol/l had mortality risks similar to those diabetic subjects defined by an FPG ≥7.0 mmol/l.
CONCLUSIONS—The relation between mortality and glucose was J shaped rather than showing threshold effect at high glucose levels, except for CVD mortality and 2hPG, where the relation was graded and increasing.
SELECTED CASE
An asymptomatic 34-year-old white man was referred to the Lipid Clinic of the National Heart, Lung, and Blood Institute for atherosclerotic cardiovascular disease risk assessment. His father died at the age of 39 years of a myocardial infarction, and his 2 paternal uncles developed symptomatic coronary artery disease by the age of 40 years. The search for conventional cardiovascular disease risk factors was unrevealing. The patient exercised regularly and had never smoked tobacco products. Physical examination revealed a normotensive man within 5% of his ideal body weight. His fasting concentrations of blood glucose (5.33 mmol/L [96 mg/dL]), low-density lipoprotein cholesterol (LDL-C) (1.76 mmol/L [68 mg/ dL]) and high-density lipoprotein cholesterol (HDL-C) (1.06 mmol/L [41 mg/dL]) were all within normal limits. However, his fasting plasma triglyceride concentration was increased (6.64 mmol/L [588 mg/dL]) as was his apolipoprotein B concentration at 3.90 mmol/L (151 mg/dL) (normal range, 1.94-3.33 mmol/L [75-129
Objective:
To assess whether the relative and absolute benefit of hypertension treatment in women varies with age or race.
Design:
Systematic review of studies from 1966 to 1998 using MEDLINE, reviews, and consultation with experts. Eleven randomized controlled trials of pharmacologic treatment of prJgiary hypertension with cardiovascular morbidity and mortality outcomes were selected, with a pooled population of 23,000 women. Relative risks were combined for each end point to form a summary risk ratio using meta-analytic techniques based on a random-effects model. Summary risk ratios were converted to numbers needed to treat (NNTs). Data were dichotomized by age to approxJgiate menopausal status (30 to 54 years, and 55 years and older), and by race (white and African American).
Main results:
In women aged 55 years or older (90% white), hypertension treatment resulted in a 38% risk reduction in fatal and nonfatal cerebrovascular events (95% confidence interval [CI] 27%, 47%; 5-year NNT 78), a 25% reduction in fatal and nonfatal cardiovascular events (95% CI 17%, 33%; 5-year NNT 58), and a 17% reduction in cardiovascular mortality (95% CI 3%, 29%; 5-year NNT 282). In women aged 30 to 54 years (79% white), hypertension treatment resulted in a 41% risk reduction in fatal and nonfatal cerebrovascular events (95% CI 8%, 63%; 5-year NNT 264), and a 27% risk reduction in fatal and nonfatal cardiovascular events (95% CI 4%, 44%; 5-year NNT 259). Hypertension treatment in African-American women (mean age, 52 years) reduced the risk of fatal and nonfatal cerebrovascular events by 53% (95% CI 29%, 69%; 5-year NNT 39), fatal and nonfatal cardiovascular events by 45% (95% CI 18%, 63%; 5-year NNT 21), fatal and nonfatal coronary events by 33% (95% CI 6%, 52%; 5-year NNT 48), and all-cause mortality by 34% (95% CI 14%, 49%; 5-year NNT 32). Analyses in white women aged 30 to 54 years did not show any statistically significant treatment benefit or harm.
Conclusions:
Hypertension treatment lowers the relative and absolute risk of cardiovascular morbidity and mortality in women aged 55 years and older and in African-American women of all ages. A greater effort should be made to increase awareness and treatment in these groups of women. Although relative risk reductions for cerebrovascular and cardiovascular events are sJgiilar for younger and older women, the NNT of younger women is at least 4 tJgies higher. Decisions about treatment of hypertension in younger white women should be influenced by the individual patient's absolute risk of cardiovascular disease.
To review the literature about the health benefits of far-infrared sauna (FIRS) use.
A search of Web of Science, EBSCO, Ovid MEDLINE, Ovid HealthSTAR, and EMBASE using the terms far-infrared and sauna, refined by limiting the search to studies of humans published in English, yielded 9 relevant papers (level I or level II evidence).
Far-infrared saunas are approved by the Canadian Standards Association and are sold to the public. The manufacturers claim numerous health benefits; however, the published evidence to substantiate these claims is limited. Four papers support the use of FIRS therapy for those with congestive heart failure and 5 papers support its use for those with coronary risk factors.
There is limited moderate evidence supporting FIRS efficacy in normalizing blood pressure and treating congestive heart failure; fair evidence, from a single study, supporting FIRS therapy in chronic pain; weak evidence, from a single study, supporting FIRS therapy in chronic fatigue syndrome; weak evidence, from a single study, supporting FIRS therapy for obesity; and consistent fair evidence to refute claims regarding the role of FIRSs in cholesterol reduction.
To measure the magnitude and timing of seasonal variation of blood pressure and related factors in the elderly living in the community, and to assess their potential impact on cardiovascular risk.
Prospective study; from January 1991 to February 1992 blood pressure and other variables were measured at 2-monthly intervals in each subject in their own homes.
Ninety-six men and women, age range 65-74 years, recruited from a single group general practice in Cambridge.
Seasonal variation of blood pressure, seasonal variation of prevalence of hypertension, seasonal variation of ambient temperature and body mass index.
Both systolic (SBP) and diastolic blood pressure (DBP) were greatest during the winter across the whole distribution of blood pressure. There was a fourfold increase in the proportion of subjects with blood pressures > 160/90 mmHg in winter compared with in summer. Regression analysis revealed highly significant seasonal differences in both SBP and DBP. After adjustment for confounding seasonal effects, a 1 degree C decrease in living-room temperature was associated with rises of 1.3 mmHg in SBP and 0.6 mmHg in DBP.
Seasonal variation of blood pressure is heightened in older adults and may partly explain the greater cardiovascular disease mortality of elderly subjects during the winter. The blood pressures of elderly people may be inversely related to the ambient temperature. The public health implications of these findings deserve further investigation.
In summary, sauna baths are well tolerated and pose no risk to healthy people from infancy to old age, including healthy women in their uncomplicated pregnancy. The normal sauna bath, with moderate cool-off phases, increases the cardiac work load about as much as a brisk walk. It has been well established that the sauna bath, no matter what the cool-off type, does not pose any circulatory risk to healthy people. Cardiovascular patients with essential hypertension, coronary heart disease or past myocardial infarction, who are stable and relatively asymptomatic in their everyday life may also take sauna baths without undue risk. As a rule of thumb, if a person can walk into a sauna, he or she can walk out of it. Misuse and abuse of the sauna are another matter.
(1) To evaluate the evidence relating to the effectiveness of methods to prevent and treat obesity, and (2) to provide recommendations for the prevention and treatment of obesity in adults aged 18 to 65 years and for the measurement of the body mass index (BMI) as part of a periodic health examination.
In adults with obesity (BMI greater than 27) management options include weight reduction, prevention of further weight gain or no intervention.
The long-term (more than 2 years) effectiveness of (a) methods to prevent obesity and (b) methods to treat obesity.
MEDLINE was searched for articles published from 1966 to April 1998 that related to the prevention and treatment of obesity; additional articles were identified from the bibliographies of review articles and the listings of Current Contents. Selection criteria were used to limit the analysis to prospective studies with at least 2 years' follow-up. BENEFITS, HARM AND COSTS: Health benefits of weight reduction were evaluated in terms of alleviation of symptoms, improved management of obesity-related diseases and a reduction in major clinical outcomes. The health risk of weight-reduction methods were briefly evaluated in terms of increased mortality and morbidity.
The recommendations of this report reflect the commitment of the Canadian Task Force on Preventive Health Care to provide a structured, evidence-based appraisal of whether a manoeuvre should be part of a periodic health examination.
(1) Prevention: There is insufficient evidence to recommend in favour of or against community-based obesity prevention programs; however, because of considerable health risks associated with obesity and the limited long-term effectiveness of weight-reduction methods, the prevention of obesity should be a high priority for health care providers (grade C recommendation). (2) Treatment: (a) For obese adults without obesity-related diseases, there is insufficient evidence to recommend in favour of or against weight-reduction therapy because of a lack of evidence supporting the long-term effectiveness of weight-reduction methods (grade C recommendation); (b) for obese adults with obesity-related diseases (e.g., diabetes mellitus, hypertension), weight reduction is recommended because it can alleviate symptoms and reduce drug therapy requirements, at least in the short term (grade B recommendation). (3) Detection: (a) for people without obesity-related diseases, there is insufficient evidence to recommend the inclusion or exclusion of BMI measurement as part of a periodic health examination, and therefore BMI measurement is left to the discretion of individual health care providers (grade C recommendation); (b) for people with obesity-related diseases, BMI measurement is recommended because weight reduction should be considered with a BMI of more than 27 (grade B recommendation).
The findings of this analysis were reviewed through an iterative process by the members of the Canadian Task Force on Preventive Health Care.
The Canadian Task Force on Preventive Health Care is funded through a partnership between the Provincial and Territorial Ministries of Health and Health Canada.
We sought to determine whether sauna therapy, a thermal vasodilation therapy, improves endothelial function in patients with coronary risk factors such as hypercholesterolemia, hypertension, diabetes mellitus and smoking.
Exposure to heat is widely used as a traditional therapy in many different cultures. We have recently found that repeated sauna therapy improves endothelial and cardiac function in patients with chronic heart failure.
Twenty-five men with at least one coronary risk factor (risk group: 38 +/- 7 years) and 10 healthy men without coronary risk factors (control group: 35 +/- 8 years) were enrolled. Patients in the risk group were treated with a 60 degrees C far infrared-ray dry sauna bath for 15 min and then kept in a bed covered with blankets for 30 min once a day for two weeks. To assess endothelial function, brachial artery diameter was measured at rest, during reactive hyperemia (flow-mediated endothelium-dependent dilation [%FMD]), again at rest and after sublingual nitroglycerin administration (endothelium-independent vasodilation [%NTG]) using high-resolution ultrasound.
The %FMD was significantly impaired in the risk group compared with the control group (4.0 +/- 1.7% vs. 8.2 +/- 2.7%, p < 0.0001), while %NTG was similar (18.7 +/- 4.2% vs. 20.4 +/- 5.1%). Two weeks of sauna therapy significantly improved %FMD in the risk group (4.0 +/- 1.7% to 5.8 +/- 1.3%, p < 0.001). In contrast, %NTG did not change after two weeks of sauna therapy (18.7 +/- 4.2% to 18.1 +/- 4.1%).
Repeated sauna treatment improves impaired vascular endothelial function in the setting of coronary risk factors, suggesting a therapeutic role for sauna treatment in patients with risk factors for atherosclerosis.
The purpose of this study was to determine the mechanism by which 60 degrees C sauna treatment improves cardiac function in patients with chronic heart failure (CHF).
We have previously reported that repeated 60 degrees C sauna treatment improves hemodynamic data and clinical symptoms in patients with CHF. We hypothesized that the sauna restores endothelial function and then improves cardiac function.
Twenty patients (62 plus minus 15 years) in New York Heart Association (NYHA) functional class II or III CHF were treated in a dry sauna at 60 degrees C for 15 min and then kept on bed rest with a blanket for 30 min, daily for two weeks. Ten patients with CHF, matched for age, gender and NYHA functional class, were placed on a bed in a temperature-controlled (24 degrees C) room for 45 min as the nontreated group. Using high-resolution ultrasound, we measured the diameter of the brachial artery at rest and during reactive hyperemia (percent flow-mediated dilation, %FMD: endothelium-dependent dilation), as well as after sublingual administration of nitroglycerin (%NTG: endothelium-independent dilation). Cardiac function was evaluated by measuring the concentrations of plasma brain natriuretic peptide (BNP).
Clinical symptoms were improved in 17 of 20 patients after two weeks of sauna therapy. The %FMD after two-week sauna treatment significantly increased from the baseline value, whereas the %NTG-induced dilation did not. Concentrations of BNP after the two-week sauna treatment decreased significantly. In addition, there was a significant correlation between the change in %FMD and the percent improvement in BNP concentrations in the sauna-treated group. In contrast, none of the variables changed at the two-week interval in the nontreated group.
Repeated sauna treatment improves vascular endothelial function, resulting in an improvement in cardiac function and clinical symptoms.
Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetic people have cardiovascular disease (CVD) risk factors comparable to those of nondiabetics who have had a myocardial infarction or stroke. Physiologic changes in diabetic hypertensive people include endothelial dysfunction, altered platelet activity, and microalbuminuria, all of which may increase coronary heart disease risk. Hyperglycemia and dyslipidemia have been shown to effect physiologic changes in the vasculature; therefore, establishing normoglycemia, reducing cholesterol levels, and controlling blood pressure are the primary and initial goals in the management of diabetic hypertensive patients. The atherosclerotic risk is greatest in poorly controlled patients, possibly because of associated hypercholesterolemia and hypertriglyceridemia. Aggressive management of risk factors such as hypertension, dyslipidemia, and platelet dysfunction in diabetics has been shown to reduce morbidity and mortality in prospective randomized controlled clinical trials. In this article we review the impact of diabetes mellitus on cardiovascular morbidity and mortality.
This article describes the American College of Physicians' guidelines for managing hypertension in patients with type 2 diabetes mellitus. It answers the following questions: 1) What are the benefits of tight blood pressure control in type 2 diabetes? 2) What are appropriate target levels of systolic blood pressure and diastolic blood pressure for patients with type 2 diabetes? and 3) Are certain antihypertensive agents more effective in patients with diabetes?
Several classes of drugs are used to treat hypertension but how they affect cardiovascular morbidity and mortality in high-risk patients is still under investigation. Recent outcome trials have examined the benefits associated with different levels of blood pressure control or have compared several of the 'newer' classes of antihypertensive drugs, such as angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers, with 'older' drug classes, such as diuretics and beta-blockers. Other trials have compared antihypertensive drugs with placebo. We performed a meta-regression analysis of 30 clinical trials that included a total of 149,407 patients. We based our analysis on summary statistics reported in the literature, and showed that blood pressure gradients accounted for most, if not all, of the differences in outcome in patients with hypertension or at high cardiovascular risk. We also conducted a study in older patients with isolated systolic hypertension and showed that antihypertensive drug treatment starting with the dihydropyridine calcium channel blocker, nitrendipine, reduced the risk of stroke and all cardiovascular complications. In addition, nitrendipine-based blood pressure-lowering therapy decreased the incidence of dementia. In diabetic patients, nitrendipine reduced the risk of proteinuria, decreased total mortality, and markedly improved cardiovascular prognosis. Taken together, these findings emphasize the desirability of tight blood pressure control.
Congenital cardiovascular malformations (CCM) cause substantial neonatal morbidity and mortality. Known risk factors for CCM explain only 10–20% of all cases. Few studies have examined mothers’ physical exposures during pregnancy and the risk of CCM in their offspring. This study examined the association between exposures to extreme temperatures, prolonged standing, and heavy lifting during early pregnancy and risk of CCM in offspring.
Using a case-control study design, 502 cases and 1066 controls were drawn from the population of all liveborn infants born between January 1988 and June 1991 to mothers living in 14 counties in New York State. Cases were identified from a population-based registry of congenital malformations. Controls were randomly selected from birth certificate records. Interviews were conducted by telephone, using a structured questionnaire. Exposure estimates were based on women's self-reports of conditions in the residence and workplace. Eighty-three per cent of the mothers were white, and 66% were between 25 and 34 years old.
After adjusting all results for known risk factors and confounding variables, we found no significant increased risk of CCM in subjects whose mothers reported being exposed during early pregnancy to extreme heat (OR = 1.13, 95% CI 0.59, 2.19), nor to extreme cold (OR = 1.19, 95% CI 0.66, 2.15). Mothers who reported ever using a hot tub, hot bath, or sauna during early pregnancy had no increased risk of CCM in their offspring (OR = 0.88, 95% CI 0.65, 1.18). Performing heavy lifting during early pregnancy did not increase the risk of CCM in offspring (OR = 0.80, 95% CI 0.57, 1.11). Prolonged standing during early pregnancy was not associated with an increased risk of CCM in children (OR = 1.03, 95% CI 0.82, 1.28). Thus if these maternal exposures have an adverse effect, it is unlikely to involve CCMs.
Seasonal variations influence blood pressure (BP) in healthy persons. Its effects on BP in renal replacement therapy, especially after renal transplantation (RTX), have not been proven clearly. We studied 80 stable RTX and 82 hemodialysis (HD) patients for 4 years. Systolic and diastolic BP, body weight (BW), cholesterol (Chol), triglyceride (TG), fasting blood sugar (FBS), blood urea nitrogen (BUN), and creatinine (Cr) were measured monthly. Their relationship with environmental temperature and humidity changes were assessed by Pearson tests and Fourier analysis. Ambient temperature and humidity were between 2.5 degrees C to 25.4 degrees C and 68% to 31% in the winters versus summers, respectively. The mean systolic BP in HD patients was 144 +/- 18 mm Hg and 140 +/- 15 mm Hg during the winter and summer, respectively (P =.004). For the RTX recipients, it was 133 +/- 12 mm Hg in winter and 128 +/- 19 mm Hg in summer (P <.001). The decrement in diastolic BP in warmer seasons was even more significant than that in systolic BP in both HD and RTX groups. Also, BW in summer was significantly lower than winter among HD (61.1 +/- 10 kg vs 63.2 +/- 9 kg; P <.001) and RTX (64.4 +/- 8 kg vs 65.6 +/- 8.4; P <.001) groups. Serum Chol, TG, and FBS did not change significantly during summer and winter in the both groups. Among RTX recipients, BUN level was greater in summer than winter seasons (24.2 +/- 15 vs 39.4 +/- 20 mg/dL; P =.01), but serum Cr did not differ. The degree of humidity did not correlate with BP, BW, or the above biochemical markers. We conclude that BP and BW are decreased in warmer seasons in both HD and RTX patients. The changes are not accompanied by changes in biochemical markers except for BUN in RTX patients.
The physiologic effect of the sauna in human beings has been studied extensively, but only recently have there been studies to suggest sauna can be an effective therapeutic modality for patients with cardiovascular disease, especially for those with congestive heart failure. The data reported to date have been promising, but definitive studies are not possible because sauna treatment would be difficult to evaluate in a double-blind, placebo-controlled study.
This paper describes the successful treatment of two patients with chronic fatigue syndrome (CFS) using repeated thermal therapy.
Two patients with CFS underwent treatment with prednisolone (PSL), with no satisfactory effect. They were subjected to thermal therapy that consisted of a far-infrared ray dry sauna at 60 degrees C and postsauna warming. The therapy was performed once a day, for a total of 35 sessions. After discharge, these subjects continued the therapy once or twice a week on an outpatient basis for 1 year.
Symptoms such as fatigue, pain, sleep disturbance, and low-grade fever were dramatically improved after 15 to 25 sessions of thermal therapy. Although PSL administration was discontinued, the subjects showed no relapse or exacerbation of symptoms during the first year after discharge. The patients became socially rehabilitated 6 months after discharge.
These results suggest that repeated thermal therapy might be a promising method for the treatment of CFS.
It has been reported that local thermal therapy with a hot pack or paraffin relieves pain. We hypothesized that systemic warming may decrease pain and improve the outcomes in patients with chronic pain. The purpose of this study was to clarify the effects of systemic thermal therapy in patients with chronic pain.
Group A (n = 24) patients with chronic pain were treated by a multidisciplinary treatment including cognitive behavioral therapy, rehabilitation, and exercise therapy, whereas group B (n = 22) patients were treated by a combination of multidisciplinary treatment and repeated thermal therapy. A far-infrared ray dry sauna therapy and post-sauna warming were performed once a day for 4 weeks during hospitalization. We investigated the improvements in subjective symptoms, the number of pain behavior after treatment and outcomes 2 years after discharge.
The visual analog pain score, number of pain behavior, self-rating depression scale, and anger score significantly decreased after treatment in both groups. After treatment, the number of pain behavior was slightly smaller (p = 0.07) and anger score was significantly lower in group B than those in group A (p = 0.05). Two years after treatment, 17 patients (77%) in group B returned to work compared with 12 patients (50%) in group A (p < 0.05).
These results suggest that a combination of multidisciplinary treatment and repeated thermal therapy may be a promising method for treatment of chronic pain.
We sought to determine the safety and efficacy of repeated 60 degrees C sauna bathing in patients with chronic systolic congestive heart failure (CHF).
This study included 15 hospitalized CHF patients (New York Heart Association class = 2.8 +/- 0.4) in stable clinical condition on conventional treatments. Sauna bathing was performed once per day for 4 weeks. Repeated sauna bathing was safely completed without any adverse effects in all patients. Symptoms improved in 13 of 15 patients after 4 weeks. Sauna bathing decreased systolic blood pressure without affecting heart rate, resulting in significant decrease in the rate-pressure product (6811 +/- 1323 to 6292 +/- 1093). Echocardiographic left ventricular ejection fraction was significantly increased from 30 +/- 11 to 34 +/- 11%. Sauna bathing significantly improved exercise tolerance manifested by prolonged 6-minute walking distance (388 +/- 110 to 448 +/- 118 m), increased peak respiratory oxygen uptake (13.3 +/- 1.8 to 16.3 +/- 2.1 mL/kg/min), and enhanced anaerobic threshold (9.4 +/- 1.2 to 11.5 +/- 1.9 mL/kg/min). Four-week bathing significantly reduced plasma epinephrine (40 +/- 42 to 21 +/- 23 pg/mL) and norepinephrine (633 +/- 285 to 443 +/- 292 pg/mL). Sauna bathing reduced the number of hospital admission for CHF (2.5 +/- 1.3 to 0.6 +/- 0.8 per year).
Repeated 60 degrees C sauna bathing was safe and improved symptoms and exercise tolerance in chronic CHF patients. Sauna bathing may be an effective adjunctive therapy for chronic systolic CHF.
Lifestyle modification, although often neglected, is an important strategy to prevent and treat hypertension and reduce antihypertensive drug burden.1,2 On a population-wide basis, even a modest reduction in blood pressure of 3 mm Hg may reduce the rate of death due to stroke by 8% and coronary artery disease by 5%.1 Here we provide a summary of the expected reductions in blood pressure that may be achieved with various lifestyle interventions (Table 1).
Table 1
Rajdeep Padwal General Internal Medicine University of Alberta Edmonton, Alta. Norman Campbell Department of Medicine University of Calgary Calgary, Alta. Rhian M. Touyz Department of Nephrology University of Ottawa Ottawa, Ont. For the Canadian Hypertension Education Program
Lifestyle modification should be the primary therapeutic intervention in individuals with the dysmetabolic syndrome, given the fact that obesity, unhealthy diet, and physical inactivity are primary underlying risk factors for its development. Most individuals with the dysmetabolic syndrome need to lose weight through dietary changes and increases in physical activity. Modest weight losses may significantly improve all aspects of the syndrome. Because individuals differ in their lifestyles, tailoring interventions to meet the specific needs of each person will maximize the chances of success. Assessment of the individual with the dysmetabolic syndrome involves quantification of obesity, diets and dietary patterns, physical activity, emotional problems, and motivation. To help individuals make lifestyle changes, a number of behavior modification strategies have shown good efficacy. These strategies include a tailored problem-solving intervention, involving goal-setting, self-monitoring, stimulus control, cognitive restructuring, stress management, relapse prevention, social support, and contracting. The frequency of self-monitoring is an especially important strategy for continued success. Research studies have clearly demonstrated the power of lifestyle modification for long-term behavioral change. Lifestyle modification appears effective in delaying or preventing the development of the dysmetabolic syndrome.
1 but the number of things we have to manage can make caring for patients with diabe- tes a challenge. To try to improve the quality and consistency of my care, I have made several changes in my practice.
The objective of this report is to combine the data from an earlier adult study with the data from a paediatric study in order to determine the overall accuracy of the BpTRU (BPM-100 model) as compared to the recognized standard, auscultatory mercury sphygmomanometer.
The individual blood pressure points recorded for both adult and paediatric studies were compared directly to its corresponding observer reference measurements from data collected and stored from the two separate studies. There were 255 sets of readings in the adult study and 162 sets from the paediatric study, which were combined to make 417 pairs of blood pressure readings for this study.
The overall observer standard reference mean for the 417 measurements was calculated and the difference between this and the overall mean BPM-100 was calculated with SD and ranges. Measurements within 5, 10 and 15 mmHg agreement were expressed as percentages.
A total of 121 subjects were included for this study (85 from the adult study and 36 from the paediatric study). From these, 417 paired measurements were recorded. The mean difference between the BpTRU and the reference standard systolic blood pressure (BP) was 0.47+/-5.40 mmHg with 89.2% measurements within 5 mmHg, 96.4% within 10 mmHg and 99.3% within 15 mmHg. The mean difference between the BpTRU and reference diastolic BP was -2.12+/-5.93 mmHg with 81.1% within 5 mmHg, 92.1% within 10 mmHg and 97.6% within 15 mmHg.
The BpTRU has been shown to be an accurate non-invasive blood pressure monitoring device in the general population over a wide range of ages (3-83 years). This combined study meets all requirements of the Association of Advancement of Medical Instrumentation and achieved a grade 'A' in the BHS protocol.
The BpTRU automatic blood pressure hypertension
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Diabetes stages of change. Methodology and study design
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Clinical benefit of inten-sive blood pressure lowering in obese patients with coronary artery disease. A Camelot substudy
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Long-term survival by hypertension status for white and black men and women
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Physical activity: 2003 clinical practice guide-lines highlights
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