This week in the BMJ

Volume 332, Number 7542, Issue of 18 Mar 2006

Blood pressure drop in MONICA populations is not from use of antihypertensives
Energy supplements may not be necessary for children with cystic fibrosis
Guidelines on blood pressure after stroke may not apply to primary care
Longer needles needed for gluteal intramuscular injections
What works for osteoarthritis?

Blood pressure drop in MONICA populations is not from use of antihypertensives

The declining blood pressures seen in many industrialised countriesare not attributable to use of antihypertensive drugs. Tunstall-Pedoeand colleagues (p 629) pooled the results from the MONICA project(which monitored cardiovascular disease in 38 populations in21 industrialised countries from the mid-1980s to the mid-1990s)to examine patterns in the blood pressure declines that hadbeen reported in most populations. The changes in blood pressurewere not due to declines in high readings only, which wouldbe attributable to better hypertension control in that group;instead, blood pressure fell similarly in groups with low, middle,and high blood pressure.

Credit: SHEILA TERRY/SPL

Energy supplements may not be necessary for children with cystic fibrosis

When children with cystic fibrosis and suboptimal nutritionreceive regular dietary advice, providing oral protein energysupplements confers no additional improvement in nutritionalstatus. In a multicentre randomised trial of more than 100 moderatelymalnourished children aged 2-15 years with cystic fibrosis,Poustie and colleagues (p 632) found no difference in mean changein body mass index centile or other nutritional and spirometricoutcomes from baseline to 12 months between the children whoreceived dietary advice plus dietary supplements and those whoreceived only advice.

Credit: SIMON FRASER/SPL

Guidelines on blood pressure after stroke may not apply to primary care

Typical primary care patients with cerebrovascular disease havevery different characteristics than those of participants inthe PROGRESS trial, on which national guidelines for blood pressurelowering are based. In a cross sectional survey, Mant and colleagues(p 635) looked at characteristics of more than 500 representativeprimary care patients with confirmed stroke or transient ischaemicattack. They found important differences in age, sex, time sincelast cerebrovascular event, blood pressure, and use of antihypertensivedrugs between their patient group and PROGRESS participants.

Credit: JUSTINE DESMOND/WELLCOME PHOTO LIBRARY

Longer needles needed for gluteal intramuscular injections

Because of increasing obesity, gluteal muscles may be beyondthe reach of standard green and blue needles in many patients.In a retrospective study, Nisbet (p 637) examined gluteal intramuscularinjection sites of 100 consecutive patients who had had computedtomography of the pelvis. He found that muscle depth was greaterthan the maximum reach of a green needle (35 mm) at the ventroglutealand dorsogluteal sites in 12 and 43 patients respectively. In26 and 72 patients the site depths were more than 25 mm (extentof a blue needle). Nisbet recommends that intramuscular glutealinjections should be avoided for most drugs or longer needlesshould be used.

What works for osteoarthritis?

In order to control pain, improve function, and alter the diseaseprocess, patients with osteoarthritis should be managed witha combination of methods, say Hunter and Felson on page 639.Non-pharmacological management such as weight loss, physicaltherapy, and knee braces should be tried before drug treatment,and surgery should be considered only when effective medicaltreatment has failed. The authors review diagnosis and investigationand summarise current knowledge about epidemiology and managementof this common joint disease.