Wednesday, 26 June 2013


I’m new to this blogging concept so you may have to forgive me if this seems a little flat – perhaps it’s because I’ve been cutting back on my morning coffee. But thankfully there is light at the end of the tunnel, and it’s all down to the French. Merci mes amis!

Last week I blogged on blood pressure and possible lifestyle choices that people can make to lessen their blood pressure and thus improve their cardiovascular risk profile. I hadn’t expected to return to that subject quite so quickly but you see coffee is dear to my heart and recently people have been asking me about coffee intake and blood pressure; so I couldn’t turn down this opportunity to comment on new research from our colleagues in France. See F. Thomas-Jean, B. Pannier, et al.

Years ago during a health screening it was noted that my blood pressure was high. Since then I’ve surprised my inner skeptic by reducing my readings to an acceptable level by changing my diet, decreasing my salt intake, losing weight and exercising more. The sceptic in me was not surprised that my blood pressure fell as there is ample evidence to support this. What surprised is that it fell by so much. In spite of this my intake of coffee has been questioned.

Now to some, my consumption of coffee is a tad excessive; to me every drop is a glorious moment so it is possible that I’ve been over-doing it. But thankfully I might now be in a position to justify taking another cup.
Presented this week during the European Society of Hypertension (ESH) 2013 Scientific Sessions, research showed a small but statistically significant reduction in both systolic and diastolic blood pressure for individuals who drank tea or coffee. Granted this research was retrospective and based on a self reported questionnaire and indeed was unable to define the exact caffeine content of the beverages consumed, so it will probably be challenged.

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However there is a paucity of good evidence in relation to links between coffee and high blood pressure. The most recent ESH/ESC guidelines back this up, as summarised by the following quote. “With regard to coffee consumption, a recent systematic review found that most of the available studies (10 RCTs and 5 cohort studies) were of insufficient quality to allow a firm recommendation to be given for or against coffee consumption as related to hypertension.”

Given this lack of clarity overall I think I’m going to embrace the new findings for the time being. Now for a quick trip to the patisserie and a small espresso.

Friday, 21 June 2013

Lifestyle Changes for Patients with High Blood Pressure

This week, the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) published new guidelines in relation to the diagnosis and management of high blood pressure. This welcome development comes out before the long awaited US guidelines which are being produced by the Joint National Committee (JNC) on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-8), which are expected later this year.

Targets for those patients with high blood pressure have been simplified. For most people with high blood pressure the recommendations are now to treat to keep systolic blood pressure below 140mmHg. Although certain subgroups have different recommendations: e.g. the elderly, those with existing heart or kidney problems and those with diabetes for example.

However, the European societies have been clear to state that these guidelines are just that, guidelines. They are not expected to apply in every case and they are not meant to be restrictive to physicians’ management practice. Indeed whilst encouraging a holistic approach, the new guidelines are clear that management options need to be in line with cardiovascular disease risk analysis.

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Interestingly, lifestyle changes for lowering blood pressure have been addressed in the new guidelines. This will likely be of interest to those individuals who have undergone a health screening program. The guidelines have this to say about lifestyle changes: “Appropriate lifestyle changes are the cornerstone for the prevention of hypertension. “and “lifestyle modifications can be equivalent to drug monotherapy”. In addition, “Beside the BP-lowering effect, lifestyle changes contribute to the control of other CV risk factors and clinical conditions.”

For those who have a once-off elevated blood pressure reading during their health screen it may not be appropriate to diagnose hypertension depending on the blood pressure result. However as there is little down side to changing lifestyle, then here is a quick recap on some recommendations from the new ESH/ESC guidelines:

1.       Moderate salt intake: typical figures in the European context are a daily intake of 9 to 12g per day of salt. Ideally this should be limited to 5-6g/day.

2.       Moderate alcohol intake: a few days alcohol free and less alcohol if possible. Limit consumption to 21 units for men and 14 for women.

3.       High consumption of vegetables and fruits and other low-fat foods and diets.
Two diets have been in the news a lot recently: these are the Mediterranean diet and the DASH diet. Both have similar recommendations. For example to eat more vegetables, use low-fat dairy products, eat more dietary and soluble fibre, whole-grains, fruit and protein from plant sources. Fish, eaten twice per week, is also recommended.

4.       Optimise weight: This is tricky. Currently two measures are used to give an indication of whether a person is over-weight, these are BMI and waist circumference. Both are frequently used in health assessment although there are limitations with both measures. Nonetheless the new guidelines would advise getting the BMI to below 25kg/m2 and for waist circumference the recommendation is <102cm for men and <88cm in woman. These are the targets but getting there will involve a mixture of dietary and exercise changes.

5.       Increase in regular physical exercise: the ESH/ESC guidelines recommend at least 30 minutes of moderate intensity dynamic aerobic exercise on 5-7 days per week.

6.       Smoking cessation: Smoking causes an acute increase in BP and if stopped has multiple good effects in lowering overall cardiovascular risk. The recommendation is to advise to stop and for physicians to offer assistance where possible.

If you have had a health check recently and your blood pressure was up, you should try to implement some of the above recommendations. They will likely help and it would surely be better than having a heart attack or stroke.

Monday, 17 June 2013

5 Tips to Maximise Health Screening Programme Uptake

Health and wellness screening is an incredible way to empower employees to avoid serious illness.

To ensure uptake is maximised, here are 5 simple tips:

1. Promote Online
Circulate details of screening programmes internally. Email is a simple and trusted form of internal communication for HR to clearly explain the advantages of health screening and why it is being offered as an employee benefit.

Email is also an effective method of reminding employees of their appointment time and specific requirements such as fasting prior to blood tests. Making the process as smooth and easy as possible for the employee increases satisfaction and engagement.

2. Promote Offline
Health screening is an opportunity to build a strong relationship offline and to build recognition of your company. Hosting lunchtime information sessions and simple pop-up banners and posters can help create awareness to drive engagement. Empower local points of contact to become ambassadors for the event by providing them with the tools and support they require.

3. Ensure Consistency
Health screening has multiple steps. Initial emails, booking, promotion, screening and reporting all offer the opportunity to build a relationship with the employee through consistent messaging and branding. This is a simple concept but with the frequency of touch points in screening it is essential to maintain the trust and confidence of the employee.

If you’re sending great emails with your branding then make sure you back it up friendly medical staff and high quality engaging reports that explain results in plain english and graphically.
The most personable aspect of health screening is generally the appointment. By creating a high level of awareness a friendly nurse can engage with informed employees and really drive employee satisfaction.

4. Data Protection
Health screening is a great way to show employees that they are valued yet many may be hesitant to participate if they think their employer or insurer will have access to the data. This is a very valid concern. Be clear and transparent and explain how personal details will be kept in total confidence. Share your privacy statement and make it clear that no personal identifiable details will be shared with the employer or that any group data could invariablly identify them. The heart of data protection is being transparent.

5. Ask for Feedback

Any company that engages with health and wellness screening values their staff. Always ask and encourage feedback as each individual has a different perspective that can help you to continually improve and refine your health screening.

Doctor Time Spent Analysing Results and Creating Personalised Reports can be Reduced to 2 Minutes