Minerva

Target blood pressure for the over 75s . . . and other stories

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3843 (Published 17 August 2017) Cite this as: BMJ 2017;358:j3843

Falls and syncope

Two years ago the SPRINT trial, carried out in the US, showed advantages in treating people of 75 and older to a target blood pressure of less than 120 mm Hg. Cardiovascular events and death were reduced without an increase in falls or syncope. A community based study in Ireland raises doubts about how far these results can be generalised (JAMA Intern Med doi:10.1001/jamainternmed.2017.2924). People in the Irish study had rates of falls and syncope five times higher than the standard care group in SPRINT, which could mean that they’d be more vulnerable to adverse effects.

Coffee drinking

Coffee contains several biologically active compounds, and two billion cups are consumed worldwide every day. In the past, observational studies have implicated coffee in the causation of several diseases, but data from the very large European Prospective Investigation into Cancer and Nutrition is encouraging. Participants in the highest quarter of coffee consumption experienced the lowest all cause mortality, regardless of the country in which they lived (Ann Intern Med doi:10.7326/M16-2945).

Head injury as a risk factor for degenerative neurological disease

A retrospective study of nearly 20 000 Finnish people hospitalised after moderate or severe traumatic brain injury finds a modest increase in the incidence of dementia during a median follow- up of 10 years compared with a similarly sized group of people with minor brain injury (PLOS Med doi:10.1371/journal.pmed.1002316). The increase was specific for dementia: no increase in risk of Parkinson’s disease, motor neurone disease, or other degenerative neurological disease was observed.

Transmission of coeliac disease?

It hadn’t occurred to Minerva that coeliac disease might be transmissible, despite the fact that most patients have disease specific antibodies. But a study from Sweden takes the idea seriously, investigating the incidence of the disease in recipients of blood transfusions (Am J Epidemiol doi:10.1093/aje/kwx210). Nearly 10 000 people received blood from someone who had been diagnosed with coeliac disease, but only 14 went on to develop the disease themselves. This rate was no higher than in recipients of blood from unaffected donors.

Electroconvulsive therapy

Despite good evidence of effectiveness, use of electroconvulsive therapy is declining in the treatment of severe affective disorders. A survey in the US shows that, contrary to its public image as a treatment inflicted on the poor or destitute, electroconvulsive therapy is now most likely to be given to people who are white, possess private medical insurance, and live in affluent areas (JAMA Psychiatry doi:10.1001/jamapsychiatry.2017.1378). It was also the treatment associated with the lowest risk of psychiatric readmission.

Bad vibrations

Tuning forks that vibrate at 128 Hz are useful for testing vibration sensation. Higher frequency forks, on the other hand, should be melted down or given to musicians, according to an article in Practical Neurology (Pract Neurol doi:10.1136/practneurol-2017-001611). It makes a compelling argument that the diagnostic accuracy of Weber’s and Rinne’s tests is so low that we should cease using them, stop teaching students about them, and send patients for audiometry instead.

Good vibrations

Robert Pirsig, in his cult classic Zen and the Art of Motorcycle Maintenance, reckoned you could tell a good motorbike repair shop by the absence of a radio. No mechanic fully engaged in their work would want to be distracted by music in the background. So what should we make of a survey by Spotify and Figure 1 which found that many surgeons choose to listen to rock music while operating (https://news.spotify.com/us/2017/08/01/surgeons-soundtrack/)? To be fair, the surgeons did say that they turned it down at critical points in a procedure or if complications occurred.

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