geoffrey modest medical blogs

Orthostatic hypotension in the elderly may be associated with incident dementia (see htn  orthostatic and cognitive impair eurheartj2018 in dropbox, or d oi.org/10.1093/eurheartj/ehy418 ). Details: --Analysis of 2316 patients in the Hypertension in the Very Elderly Trial (HYVET) cohort, a double-blind study of hypertensive patients ≥80 years, randomized to indapamide 1.5mg sustained release (long-acting thiazide-like diuretic) with optional addition of the ACE-I perindopril 2-4mg. (see htn elderly HYVET nejm 2008 in dropbox for access to HYVET) --from 90 primary and secondary centers in 13 countries --all patients had no clinical diagnosis of dementia, mean SBP of 160-199 mmHg and standing SBP ≥ 140 mmHg     --mean age 83.6, 60% female, mean sitting BP 173/91 mmHg, followed mean of 2.0  years;     --study found large reductions in stroke, death from any cause, death from cardiovascular causes, and rate of heart failure --cognitive function assessed by the Mini-Mental

​ A recent large study confirmed the benefit of physical exercise on mental health (see  exercise and psych health lancetpsych2018  in dropbox or doi.org/10.1016/ S2215-0366(18)30227-X). Details: -- 1,237,194 people aged 18 or older in the US, enrolled in the Centers for Disease Control and Prevention Behavioral Risk Factors Surveillance System survey, in 2011, 2013, and 2015 -- compared the number of days of "not good" self-reported mental health in those who exercise vs not -- groups were balanced for age, race, gender, marital status, income, education level, BMI, self-reported physical health, and previous diagnosis of depression -- they assessed exercise type, duration, frequency, and intensity, adjusting for potential confounders as above Results: -- those who exercised had 1.49 (43.2%) fewer days of poor mental health the past month, after matching for physical and sociodemographic variables. -- All exercise types were associated with lower menta

The USPSTF just released their new cervical cancer screening guidelines (see https://jamanetwork.com/journals/jama/fullarticle/2697704?resultClick=1 for the recommendations, and https://jamanetwork.com/journals/jama/fullarticle/2697703 for the evidence report and systematic review). Details/Results: -- 8 RCTs (n=410,556), 5 cohort studies (n=402,615), and 1 individual participant data meta-analysis (n=176,464) were included -- primary high risk human papillomavirus (hrHPV) testing (ie, the sole test performed) vs cytology:     --increased detection of CIN 3+ on the first round of testing, ranging from RR of 1.61-7.46     --in general the detection rate was significantly lower in the second round of screening -- co-testing (both cytology plus hrHPV) vs cytology alone:     -- none of the studies showed improvement in CIN 3+ by co-testing -- false positives were:     --cytology: 2.6-10.9%     --primary hrHPV:  6.6-7.4%; culposcopy rates: 1.2-7.9% vs 1.1-3.1% for c

​t here was a trio of articles in NEJM on the utility of aspirin in healthy elderly patients (first time i've seen a trio in NEJM...), finding not much benefit and some significant harm, thereby questioning the role of aspirin in primary prevention in the healthy elderly.  this blog is a bit longer than usual, since it reviews 3 articles, but the one-liner conclusions in the press (including the medical press) that we should reconsider using aspirin in healthy older people should be a tad more nuanced. 1. Aspirin effects on cardiovascular events and bleeding, the ASPREE trial (see  aspirin healthy not dec cardiovasc NEJM2018  in dropbox. or DOI: 10.1056/NEJMoa1805819) Details: -- 19,114 community - dwelling men and women in Australia and the United States who were 70 years old or older (65 or older for black and Hispanic people in the United States). All were initially free of overt coronary heart disease, overt cerebrovascular disease, atrial fibrillation, a clinical dia