New European High Blood Pressure Guidelines

1. The European Society of Hypertension and the European Society of Cardiology has come out with new guidelines for the management of high blood pressure.

2. The new recommendation is that all blood pressure patients should be treated to keep the upper blood pressure lowers 140 mm Hg.

3. In patients with diabetes the lower blood pressure should be kept lower than 85 mm Hg

4. In patients younger than 80 years, the upper blood pressure can be kept 140-150 mm Hg

5. Blood pressure more than 140/90 increases the risk of cardiovascular disease.

6. The salt recommendation is 5 to 6 gram per day. 

7. Reduce salt to 5 gram per day can reduce upper blood pressure by up to 2 mm Hg in normal persons and 4 to 5 mm Hg with patients with high blood pressure.

8. Loosing 5 kg. of weight can reduce upper blood pressure by 4 mm Hg.

9. Regular aerobic exercise training in high blood pressure patients can reduce upper blood pressure by 7 mm Hg.

10. Drug therapy should be started typically within a few weeks if diet and exercise should be started as first line without indicated.

11. The main aim of treatment is to lower blood pressure rather than how it is lowered.

12. ACE inhibitors and AR blockers should not be combined.

13. Those people whose blood pressure is not getting controlled renal denervation surgery should be considered.

Emedinews:Insights on Medicolegal Issues:WMA declaration of Malta on hunger strikers – Guidelines for medical management

The doctor must assess the mental capacity of the individual. This involves verifying that an individual intending to fast does not have a mental impairment that would seriously undermine the person’s ability to make health care decisions. Individuals with seriously impaired mental capacity cannot be considered to be hunger strikers. They need to be given treatment for their mental health problems rather than allowed to fast in a manner that risks their health.

As early as possible, physicians should acquire a detailed and accurate medical history of the person who is intending to fast. The medical implications of any existing condition should be explained to the individual. Physicians should verify that hunger strikers understand the potential health consequences of fasting and forewarn them in plain language of the disadvantages. Physicians should also explain how damage to health can be minimized or delayed by, for example, increasing fluid intake. Since the person’s decisions regarding a hunger strike can be momentous, ensuring full patient understanding of the medical consequences is critical. Consistent with best practices for informed consent in health care, the physician should ensure that the patient understands the information conveyed by asking the patient to repeat back what they understand.

Emedinews:Insights on Medicolegal Issues:World Medical Association (WMA) guidelines for medical doctors in biomedical research involving human subjects

• Doctors should abstain from engaging in research projects involving human subjects unless they are satisfied that the hazards involved are believed to be predictable. Doctors should cease any investigation if the hazards are found to outweigh the potential benefits.
• In publication of the results of his or research, the doctor is obliged to preserve the accuracy of the results. Reports of experimentation not in accordance with the principles laid down in this Declaration should not be accepted for publication.
• In any research on human beings, each potential subject must be adequately informed of the aims, methods, anticipated benefits and potential hazards of the study and the discomfort, it may entail. He or she should be informed that he or she is at liberty to abstain from participation in the study and that he or she is free to withdraw his or her consent to participation at any time. The doctor should then obtain the subject’s freely given informed consent, preferably in writing.
• When obtaining informed consent for the research project the doctor should be particularly cautious if the subject is in a dependent relationship to him or her or may consent under duress. In that case the informed consent should be obtained by a doctor who is not engaged in the investigation and who is completely independent of this official relationship.
• In case of legal incompetence, informed consent should be obtained from the legal guardian in accordance with national legislation. Where physical or mental incapacity makes it impossible to obtain informed consent, or when the subject is a minor, permission from the responsible relative replaces that of the subject in accordance with national legislation.
• The research protocol should always contain a statement of the ethical consideration involved and should indicate that the principles enunciated in the present Declaration are complied with.

(Ref: 18th World Medical Assembly, Helsinki, Finland, 1964 and revised by the 29th World Medical Assembly, Tokyo, Japan, 1975).