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Archived news.

Alcohol with food this holiday season is better for the BP

We don’t want to put a damper on your imbibing this festive season since it is the season to be merry and all that. Well not too merry as it turns out. Two or less drinks per day, and with food. That is the outcome of research by Saverio Stranges and colleagues as reported in Hypertension 2004; 44: 813-819. Despite previous studies that have shown that heavy alcohol consumption increases BP, the role of drinking pattern has not previously been studied. The study seems to suggest that moderate alcohol intake with food minimizes the risks whereas alcohol without food significantly increases risk. So take your festive cheer with food this year 

Alcohol: global burden on health similar to tobacco and hypertension.

The amount of death and disability caused by alcohol globally is similar to that caused by tobacco and high BP (Lancet 4 March.) Overall, four percent of the global burden of disease is attributable to alcohol, 4•1% to tobacco and 4•4% to hypertension. Alcohol is causally related to more than 60 different medical conditions, including breast cancer and coronary heart disease. In most cases alcohol has a detrimental effect on health. Alcohol And Public Health R Room And Others Volume 365 Number 9458 February 5–11, 2005 P519More.. 

ARBs and ACE-I least likely to lead to diabetes.

ARBs and ACE-I are the antihypertensive agents least associated with incident diabetes according to a Lancet article. The propensity for some BP-lowering drugs to reduce glucose tolerance and precipitate diabetes is well known. Some long-term clinical trials comparing antihypertensive agents have shown significant differences in the rates of new cases of diabetes between treatment groups. The association of antihypertensive drugs with incident diabetes was lowest for ARBs and ACE-I followed by calcium-channel blockers and placebo, and then beta-blockers and diuretics in rank order. The authors conclude: “This technique not only includes results of all clinical trials that directly compared two initial antihypertensive drugs, but also incorporates indirect comparisons (particularly important for ACE inhibitors versus ARBs, which have not yet been directly compared), and results in estimates that are highly coherent and robust to many sensitivity analyses.” Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Lancet. 2007:369;201-7. 

BMJ editorial on ARB causing increased risk of MI risk starts row.

It all started with an editorial in the august British Medical Journal and now heated responses are flying around the world. In the November 27, 2004 issue Verma and Strauss (BMJ 2004; 329:1248-9) warned that angiotensin-receptor blockers (ARBs) may cause increased risk of myocardial infarction. Leading clinicians and researchers have joined the fray and the SAHS Executive Committee is following the debate with keen interest.More..  Read File..

Cochrane Review on primary prevention for mulitple CVD risk factos causes a stir.

Results of a Cochrane review question whether large-scale interventions to reduce multiple cardiac risk factors are effective. (Cochrane Database Syst 2006; 4 27 October 2006. The SAHS has asked our experts to tell us what the implications are for policy and practice. The authors report that while health initiatives to reduce cholesterol levels and BP to treat diabetes, and encourage people to stop smoking and start exercising have had a small effect on coronary risk factors, they have had no clear impact on death rates from coronary heart disease (CHD) and other cardiovascular diseases (CVDs).More..  Read File..

Does The Atkins Diet Actually Work?

A Rapid Review article by Arne Astrup and colleagues discusses whether the popular Atkins diet really does produce weight loss. Over 45 million copies of the Atkins diet books have been sold, and the associated food products are also popular. Low-carbohydrate diets have been around since the 1860s, but the Atkins books are the most successful to date. Ad-libitum consumption of butter, fatty meat, and high-fat dairy products are advocated, while carbohydrate intake is restricted to under 30 g a day. Read more... From The Lancet 2004;364(9437):897More..  Read File..

Eating less salt could prevent cardiovascular disease.

People who significantly cut back on the amount of salt in their diet could reduce their chances of developing cardiovascular disease by a quarter, according to a report on bmj.com in April (BMJ Online : BMJ, doi:10.1136/bmj.39147.604896.55 published 20 April 2007). Researchers in Boston also found a reduction in salt intake could lower the risk of death from cardiovascular disease by up to a fifth. Cardiovascular disease refers to the group of diseases linked to the heart or arteries, for example a stroke or heart disease. While there is already a substantial body of evidence showing that cutting back on salt lowers blood pressure, studies showing subsequent levels of cardiovascular disease in the population have been limited and inconclusive. This research provides some of the strongest objective evidence to date that lowering the amount of salt in the diet reduces the long term risk of future cardiovascular disease, say the authors of the report. More..  Read File..

Food labelling collaboration with dieticians professional group.

The SAHS Executive has long been concerned about misleading and inadequate food labelling. We are pleased to announce that the SAHS has formed an alliance with the Association of Dieticians of South African. The alliance will assist the SAHS to be clearly informed about the delayed but required changes to the relevant legislation. We are thrilled that we have such expert partners. For more information read the attached document.  Read File..

International Study Highlights 9 Controllable Risk Factors Responsible for 90% of MIs Worldwide

A major international study from 52 countries quantifying the major risk factors for MI-and to identify any regional differences from different parts of the world or among particular ethnic groups-is detailed in the INTERHEART study. Lancet 2004; 364: 937-951 11 September 2004 Free download http://www.thelancet.com/journal/vol364/iss9438/contentsMore..  Read File..

Maseko and Becker win R5000 awards for best original research presentations.

Best oral presentation the YK Seedat award: Mr Joseph Musi Maseko. For the presentation entitled: Maseko is from the Wits School of Physiology where he works as a senior tutor. He is registered for an MSc, member of the Wits Cardiovascular Pathophysiology and Genomics Research Unit. He is also project Coordinator of the African Project on Genes in Hypertension. Best Poster Presentation the Lionel Opie award: winner Dr Anthony Becker. He is a Consultant Cardiologist ,Chris Hani-Baragwanath Hospital. The poster covered elements of his Wits PhD research which aims to answer the question if the clinical and angiographic features of HIV positive patients presenting with acute coronary syndromes differ from those of HIV negative patients. Both said that they were extremely grateful and humbled to win this award. Awards of this nature give researchers encouragement to continue. The awards were sponsored by Discovery Health.  

Measure Of Obesity Should Be Redefined To Accurately Assess Heart Attack Risk

Waist-to-hip ratio, not body mass index (BMI), is the best obesity measure for assessing a person`s risk of heart attack, concludes a global study published The Lancet (Nov 5-11,2005.). If obesity is redefined using waist-to-hip ratio instead of BMI the proportion of people at risk of heart attack increases by threefold Salim Yusuf and others. More.. 

More aggressive treatment warrented in metabolic syndrome.

More aggressive treatment with statins is necessary to lower LDL (low-density lipoprotein) cholesterol in patients with coronary heart disease and metabolic syndrome, a syndrome composing of 3 CV risk factors (see read more notes) according to an Lancet Online/Article (www.thelancet.com Published online September 5, 2006 DOI:10.1016/S0140-6736(06)69292-1). The Treating to New Targets (TNT) study was a prospective, double blind, parallel-group trial which was done at 256 sites in 14 countries between 1998 and 2004, with a median follow-up of 4.9 years. Andre J Scheen states in an accompanying Online/Comment: “The TNT findings suggest that the presence of metabolic syndrome might help select patients who will best benefit from aggressive lipid-lowering therapy”. ( www.thelancet.com Published online September 5, 2006 DOI:10.1016/S0140-6736(06)69293-3.) Source Lancet Press Office.More.. 

New ESH ESC hypertension guidelines

The 2007 European Society of Hypertension and ES Cardiology guideline on hypertension available. One of the main differences is that first line therapy is flexible with any one of the following classes: diuretic, CCB, ARB, beta-blockers. See if you can detect other differences. 

Obesity guideline (NICE) calls for urgent action.

The National Institute for Health and Clinical Excellence (NICE) has issued the first ever national guideline addressing both the prevention and treatment of obesity in adults and children. The guideline contains wide ranging recommendations for health and all levels of schools, employers (see read more). Bariatric surgery only is recommended as the last resort for adults with morbid obusity but with strict criteria. Download guideline from: http://www.nice.org.uk/cg43 More.. 

Over 80 Million Americans Risking Early Death through Smoking or Obesity

Over 80 million American adults are putting themselves at serious risk of long-term illness and early death through smoking, obesity, or both, finds a study published on bmj.com today. Smoking and obesity are two of the leading causes of death and illness in the United States, but the overlap between the two conditions has never been measured. (Article BMJ see reference below) Using data from the 2002 national health interview survey, researchers estimated the proportion of adults in the US who smoke and are obese. The results were stratified for various factors, such as income and education levels. They found that 23.5% of adults were obese and 22.7% smoked (a total of 81 million). About 4.7% (9 million) smoked and were obese. This proportion was particularly high in African Americans (7%) and in people with lower income and education levels. Although this overlap is relatively low, the presence of these two conditions together may carry an increased risk to health, say the authors. Treatments for people who smoke and who are obese need to be investigated, they add. Clinical trials should monitor the effects of programmes aimed at simultaneously stopping smoking and weight control. These results could be used to develop policies for prevention and treatment.More.. 

Past presidents honoured with honorary life membership: Mokhobo, Milne, Opie, Sareli, Seedat,and Seftel.

The SAHS has never honoured its own members and particularly those who have served with dedication and distinction. The change to the constitution was the perfect occasion, as it marks a transition point. Six past presidents of the SAHS were honoured with honorary life membership. The awards were made in recognition of their exemplary service to the Society over the last 3o years. Fiver of the past-presidents so honoured have all officially beyond retirement age but are far from retired. They are: Prof Patrick Mokhobo, Prof John Milne, Prof Lionel Opie, Prof YK Seedat and Prof Harry Seftel. An exception was made for Dr Pinky Sareli, immediate Past President, who served two terms. The SAHS Executive Committee feels he is due recognition well in advance of his retirement. Sareli is credited with transforming the SAHS through its digital platform and secretariat. If that is not enough, the Circulatory Disorders Research Fund is also his brainchild. It is for this innovative service that the SAHS honours Dr Pinky Sareli.  

Preventing kidney disease: Is BP lowering more important than drug class?

The first-line drug choices to treat high BP in patients with kidney disease may not be the best option (Lancet 2005: 366:2026-2033) National and international guidelines endorse the use of two classes of drugs - ACE inhibitors and angiotensin-II receptor blockers (ARBs)- as the firstline BP-lowering therapy in patients with kidney disease. Doctors have assumed that these drugs have specific effects to protect the kidney beyond those resulting from their ability to lower BP. More.. 

Private health care: PMBs and hypertension and circular 32 CMS

If all of this sounds foreign language, you are not alone. However, if you are involved as the provider or recipient of private medical care, it is in your interest to get to know more.The SAHS submitted its 2006 guideline to the Council for Medical Schemes (CMS) as requested in April (CMS circular 13 2006) for the revision of the hypertension algorithm. Ms Marli Weldhagen from CMS said “Due to changes in the Chronic Disease List Committee there have delays in the hypertension and other chronic illness algorithms.” The final date for publication and consultant has not been set. In addition, CMS circular 32 lays out information on implementation of Prescribed Minimum Benefits (PMBs.) The aim of this circular is to ensure the consistent quality of care and access to PMBs as laid out the Medical Schemes Act. The SAHS attended the recent CMS workshop and recommends that all private health practitioners read this important circular as it aids interpretation of PMBs  Read File..

SAHS does not support Health Charter in current format.

The purpose of the Health Charter (HC) is to facilitate and effect transformation in the health sectors. There are two main areas that require transformation according to the original HC: quality of care and broad based black economic empowerment (BBBEE). The HC is sponsored by the National Department of Health (NDoH.) Clearly the HC has an influence on the requirements of health sector organisations such as the SAHS. The SAHS feels that is important to be part of the negotiations and has involved itself in an alliance of health sector NGOs called PHANGO. PHANGO noted at the HC stakeholder consultation meeting (called by NDoH in November) that it did not have a mandate to adopt the HC in any form. Many participants at the hastily called meeting indicated that they did not have a mandate either. The main reason for concern is that the NDoH had not consulted adequately and, in particular, had not followed a transparent and defined process. Ultimately the NDoH agreed to a new process that will entail greater deliberation about the HC content and involvement of a wider development group. More..  Read File..

SAHS goes to National Parliament, Cape Town.

Plenty of BPs were taken before the Minister of Health’s budget speech on 6 June. The SAHS was present to take BPs of parliamentarians, workers and visitors and give advice and referral where necessary. Stressful stuff this working in Parliament. SAHS’s Dr Vicki Pinkney-Atkinson and Ms Nosipho Mdondolo from the National Department of Health worked all day communicating the importance of BP monitoring and compliance.  

SAHS guideline drug approach confirmed by lastest British guideline

The SAHS was first in the world to publish its guideline which redefined the medications to be used in the management of hypertension. The joint national South African hypertension guideline, published in March 2006, is spot on in its recommendations. This was confirmed by the June 28 publication updating the hypertension management guideline in the United Kingdom. The full guideline can be accessed at insert website. Prof Joe Veriava, President of the SAHS, said: “The recent British guideline follows the lead already implemented in South Africa. “The British guideline makes recommendations for the use of CCBs and ACE-I based on age, however the SAHS felt that this decision should be left to the practitioners. South Africa has a majority of black hypertensives and this must also be taken into consideration in the management.” The SAHS and British recommendations are to be found on on this website. Go to Guidelines and Resources. More.. 

SAHS guideline is both cost effective and evidence-based.

Our is both cost effective AND evidence-based. One of the keys to making it cost effective was the unanimous decision to use a CV risk assessment strategy so patients at higher risk have optimal care and use of resources. Less clear was the type of risk assessment to use:global or absolute. Considerable debate and thought went into the decision to use the absolute risk table of the European Society of Hypertension and the European Society of Cardiology guidelines. And, although there are other risk assessment models in use, the decision was based on the practicalities of implementation in primary care settings in a developing country. With hindsight our decision not to include details of the he risk levels was wrong. Its inclusion would have given more evidence and information. This is rectified by the attached document for this information. This is in response to Dr Tom Gaziano’s article, “The South African Hypertension Guideline 2006 is evidence-based and not cost-effective” (S Afr Med J 2006; 11: 1170-3.) The SAHS has responded with a letter to the Editor. We believe that a much wider debate on the most acceptable risk chart for the South African context is vital and call on all stakeholders to participate. However, it must be remember that risk charts are only guidelines and are not failsafe. They must be used in conjunction with good clinical judgment, assessment of target organ damage and recognition of associated conditions.  Read File..

SAHS meets with EDL Committee

Late last year, members of the Advisory Panel met with the Secondary Level Essential Drug List Committee. The objective of the meeting was to inform of the anticipated changes to the hypertension guideline. The meeting was cordial but the EDL Committee was hesitant to commit to any changes until it felt that it had sufficient cost effectiveness studies. The SAHS will continue to lobby on this matter. In addition, the SAHS also is concerned about the availability of the required drugs at primary care clinics and the policy regarding the primary care nurses supplying up to three drugs in patients with uncomplicated hypertension. 

SAHS members are honoured Veriava, Seedat and Steyn

Congratulations are due to to: Professor Krisela Steyn has been given a full honorary professorship in the UCY Department of Medicine. Professor Joe Veriava has been appointed academic head for the Wits Department of Medicine. Prof YK Seedat, SAHS Honorary Life Member, is the recipient of the Golden Jubilee Award by the Colleges of Medicine of South Africa.  

SAHS Prof Lionel Opie is honoured by State President

Our congratulations go to Prof Lionel Opie, SAHS Honorary Life Member and Former SAHS President, on his award of the Order of Mapungubwe in Silver for “excellent contribution to the knowledge of and achievement in the field of cardiology.” Please find attached a delightful picture of Lionel receiving the award from President Mbeki.   Read File..

SAHS submits comments on draft CMS hypertension algorithm.

Our submission on the draft algorithm is attached. NB the CMS issued a correction to the hypertension first draft.   Read File..

Sorry ISH does not give membership fee break to South Africans.

Last month`s news turned out to based on wrong information. The SAHS will keep lobbying for low International Society of Hypertension membership fees for African countries. For now we don`t qualify. We apologise for any inconvenience. 

Soweto Screening event a smash hit.

Despite the cold, there was a red hot reception at the Soweto taxi rank for the locals who wanted to have BP, cholesterol and bloods sugar screening. The Heart of Soweto Study, in collaboration with Unite for Health and the SAHS screened from dawn to dusk on 26 May. 5 Chris Hani-Baragwanath nurses were kept busy all day. One of the registered nurses, Sr Lizzie Tshele. said: “The people appreciated getting the information and we were so exhausted by the end of the day.” There were another 7 helpers who gave out pamphlets and did other essential tasks. The whole event was masterminded by Wits professor, Karen Sliwa-Hahnle. The pamphlet used for education is attached for your used courtesy of Unite for Health, The Heart of Soweto Study and the SA Hypertension Society. This project will run once a month for the next five months. Next screening at the same venue is to be held on 7th July starting 09:00. This is a screening model to copy that could be used in a modified format in other centres. Well done Heart of Soweto!   Read File..

Stroke articles July Journal Club

Intervention in the first 3 hours after a stroke is critical if we are to prevent permanent neurological damage. In this month’s Journal Club (click right button) we have a series of Lancet summaries on different aspects of stroke diagnosis and care. You assess if they could work in SA. However, the long and short of it is that it is still far cheaper to prevent stroke. And in South Africa that means controlling BP, diabetes and lipid levels and all of the lifestyle measures. As simple and as hard as that.  

Submission to Council for Medical Schemes.

The new joint national guideine and algorithm form the basis of the submission to the Council for Medical Schemes as it prepares for the revision of the hypertension guideline. The submission form is attached. The CMS chronic disease algorithms are the legal documents for the 25 conditions for which there are prescribed mininum benefits.   Read File..

Time for SAHEP - South African Hypertension Education Programme?

Read the documents on the The Canadian Hypertension Education Program (CHEP). CHEP is modelled on the 30 year old US National High Blood Pressure Education Program. Both are national programmes to improve the treatment and control of hypertension. Access CHEP documents through the Canadian Hypertension Society website www.hypertension.ca Isn`t it time that the SAHS initiated its own SAHEP? Let us have your thoughts.   Read File..

World Hypertension League Newsletter:June 06

Hypertension global epidemic. World hypertension day events.  Read File..

World Hypertension Newsletter. April 2006

Reports on the “Make it work” BP control programme and 2005 world hypertension day   Read File..

World Stroke Organization

The WSO is the result of the merging of the International Stroke Society and the World Stroke Federation. The WSO will continue the important achievements of each society in establishing stroke on the world health agenda and be identified as the single most important organization in this field.  Read File..