Combinations of drugs may add to heart disease risk.
THE QUESTION For some people with high blood pressure, lifestyle changes alone are not enough. It takes medication, and often a combination of drugs, to lower their blood pressure enough to reduce their risk of heart disease. Might combining drugs have a negative effect?
THIS STUDY compared the risk of dying from heart disease among 30,219 postmenopausal women who took an ACE inhibitor, a beta blocker, a calcium channel blocker, a diuretic or some combination of these drugs to control high blood pressure. At the start of the study, none of the women had heart disease. After about six years, women who combined a diuretic and a calcium channel blocker increased their risk of dying from heart disease by 85 percent compared with those using a diuretic/beta-blocker combination. There was little difference in risk between the ACE inhibitor/diuretic and the beta-blocker/diuretic combinations. Women who took only a calcium channel blocker had a 55 percent increased risk of death from heart disease, compared with those who took only a diuretic. Among those taking only ACE inhibitors or beta blockers, risks were similar to those taking only diuretics.
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WHO MAY BE AFFECTED BY THESE FINDINGS? Older women with high blood pressure.
CAVEATS The study was observational rather than randomized. The findings do not necessarily apply to younger women or to men.
BOTTOM LINE Older women with high blood pressure should talk with a doctor about the risks associated with various combinations of blood pressure drugs.
FIND THIS STUDY Dec. 15 issue of the Journal of the American Medical Association; abstract available online at www.jama.com.
LEARN MORE ABOUT treating high blood pressure at www.nhlbi.nih.govand www.americanheart.org.
chronic fatigue syndrome
Talk therapy seems to improve physical functioning of youths.
THE QUESTION Teenagers and tiredness go hand in hand. But something serious may be happening when the weariness doesn't disappear with sleep and is accompanied by muscle pain, headaches and difficulty concentrating. Those could be signs of chronic fatigue syndrome. Might cognitive behavior therapy help young people with this disorder?