What goes up must come down, but hypertension experts worldwide differ about ways, means

Article Abstract:

A report concerning the recent meeting of the American Heart Association (AHA) is presented, at which approaches taken by seven countries in the treatment of high blood pressure (hypertension) were compared and evaluated. Clinical reactions to hypertension (which is defined in the United States as a diastolic, or resting phase, pressure above 95 mm Hg) vary; patients may be medicated, observed for six months before treatment starts (according to the World Health Organization's recommendations), or asked to monitor their pressure themselves to avoid elevations resulting from being in the presence of a physician (Japan). Diastolic levels between 90 and 95 constitute a gray area, where physicians' judgments regarding treatment options come into play. While 5 millimeters of mercury may not seem like a lot, in an epidemiologic sense it is: in West Germany, 20 percent of the population has a pressure of 95 or greater, but if the cut-off is dropped to 90, an additional 15 percent of the population is added. American physicians at the meeting seemed in agreement with the concept that nonpharmacological approaches (diet, exercise, increased potassium intake) should be tried more often, but, as one expressed, specific guidelines for these methods are lacking. A consensus was established on the relative merits of treating younger people with hypertension, in contrast to those 75 or 80 years old, with no signs of congestive heart failure; in older people, treatment is often ineffective. Perhaps the systolic pressure (during the heart's pumping phase) is a better indicator of the patient who is at-risk; evidence to support this is presented. Should one treat the blood pressure, or the patient? Graham A. MacGregor, a speaker at the meeting, suggested that nurses might be better than physicians at following-up patients who take hypertensive medication. Families should also be asked about side effects of these drugs, he said. Overall, opinions regarding the treatment of hypertension are diverse, reflecting, perhaps, the relative lack of firm knowledge in this area. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Conferences, meetings and seminars, Hypertension, International aspects, Dosage and administration, Antihypertensive drugs, Antihypertensive agents, American Heart Association

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Dartmouth Medical School Bicentennial

Article Abstract:

Dartmouth Medical School will celebrate its bicentennial in Sept, 1997. The school was founded by Nathan Smith in 1797, but a 1911 evaluation of American medicine revealed that the college did not have access to enough patients to adequately train students in clinical medicine. The school beganoffering a 2-year program in basic sciences, at which time students would transfer to another medical school for their clinical training. When the school failed accreditation in 1956, an ambitious program to correct this deficiency was begun by S. Marsh Tenney. By 1980, the school once again offered a 4-year program.

History, Medical education, Dartmouth College. School of Medicine

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