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Contentious Thanksgiving Conversation Starters

Reading Time: 9 Minutes

Published November 5, 2022

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When It Comes to Antihypertensives? Alleviation for the Common Cold?

CARDIO CORNER

The Thanksgiving holiday is almost here, and we’ll soon have our fill of turkey, pumpkin pie, and contentious conversations with extended family. When a generous serving of politics and religion heats up the dining room, you can throw another log on the fire with this hot topic: does antihypertensive medication work better when taken in the morning or in the evening?
 
New findings from the TIME (Treatment in Morning versus Evening) study have rekindled this ongoing debate by contradicting the chronotherapy zeitgeist, or the prevailing thought that when a patient takes their blood pressure medication influences its effectiveness. In this prospective study, >21,000 adults with hypertension taking at least one antihypertensive medication were randomly assigned to morning or evening dosing and followed for a median of five years. Neither group saw a significant difference in major cardiovascular events (3.4% for the supper club and 3.7% for the breakfast club).
 
Despite the seemingly conclusive evidence from this study, its presentation at this year’s European Society of Cardiology (ESC) Congress ignited the scientific equivalent of Ali-Frazier V (we’re counting Laila Ali vs Jacqui Frazier-Lyde as Ali-Frazier IV, but we’re open for debate). Team Chronotherapy cites a mountain of prior evidence (eg, the Hygia Chronotherapy Trial) supporting evening dosing, whereas Team Nonchronotherapy questions those previous trials’ designs and asserts that chronotherapy lacks physiologic sense.

Key takeaway

The TIME study showed that among patients with hypertension, the timing of antihypertensives neither influences the number of adverse cardiovascular events nor affects safety (ie, falls). The authors suggest that clinicians advise patients to take their blood pressure medications whenever is most convenient for them. But the gavel hasn’t yet dropped on this debate. While we await more trial findings or an antihypertensive that effectively lowers blood pressure for a full 24 hours, it may be best to take this discussion off the Thanksgiving table. And if your Thanksgiving still leads to elevated blood pressure, consider SNL’s proven intervention: an Adele song—effective, safe, and soothing.

Surprising Sodium Study May Lead to a Change of Heart

DIETARY DIGEST

Let’s move on to statements we all can agree on this Thanksgiving: (1) Dolly Parton is a national treasure and (2) a low-sodium diet benefits patients with chronic heart failure. The latter stands to reason because we know that excess sodium can lead to fluid overload and that fluid overload can lead to adverse cardiovascular events. Seems incontrovertible. Pass the stuffing.

Then why did a randomized, controlled trial show otherwise? In the SODIUM-HF trial, >800 patients with chronic heart failure receiving guideline-concordant treatment were randomly assigned to a low-sodium diet (<1,500 mg/day) or usual care. At 12 months, the groups were not statistically different in a composite of cardiovascular-related hospital or ED visits or all-cause death. Events occurred in 15% of the dietary group and in 17% of the usual care group. We’re scratching our heads too.

Key takeaway

(1) Few topics are indisputable this Thanksgiving. (2) This study challenges long-held assumptions about the benefits of restricting sodium in those with heart failure and puts the “evidence” in “evidence-based medicine.” So, what is the optimal sodium intake for these patients? We checked in with Frank Domino, MD, for his thoughts: “We have known for a while that in non−heart failure patients, aggressive salt restriction leads to elevated—yes, elevated—blood pressure. Over 4,000 mg/day of salt is definitely unhealthy, but so is too little. What is optimum? Likely ~2,400 mg/day for the average person, which equals about 1 teaspoon of salt (remember, salt is not just sodium). And for heart failure patients, likely 1,500 to 2,000 mg/day.”

And the Winner Is…

Thank you all for posting your cartoon caption contest ideas. We were impressed! It was a tough call, but the Pri-Med team agreed that the following caption gave us the heartiest chuckle.

“See how happy the janitor is—he hasn’t had to explain for the 8,562nd time today to a patient why an antibiotic is not needed to treat a cold.”

Congratulations to Juliane C. Johnson, MSN, APRN, FNP-BC, at CareConnect Health in Ellaville, Georgia for penning this excellent caption!

Check out future issues of Morning Report for more cartoon caption contests.

Parkinson’s Detection Method Passes the Sniff Test

DIETARY DIGEST

Switching gears, we want to share the bittersweet story of Joy and Les Milne. It’s part Nicolas Sparks novel, part Marvel movie, and part British Medical Journal article. This incredible tale of love, loss, a superpower, and a medical breakthrough begins like any other:

Boy meets girl at a high school party. Girl with yet undiagnosed hyperosmia falls for boy’s “lovely male musk smell” and “wicked humor.” Boy and girl marry; become a physician and nurse, respectively; have 3.0 kids; and continue along their “happily ever after.” Ten years into marriage, girl notices boy’s pleasing scent has turned to a “nasty yeast smell.” Girl—in her Scottish accent—admonishes boy for “not washing properly.” Boy dismisses her nagging. Years pass and girl notices boy’s changing disposition in addition to his altered smell. They seek medical care and receive the dreaded diagnosis: boy—now a 45-year-old man—has Parkinson disease. To cope with the disease, they attend a support group for people living with Parkinson disease, and that’s when girl’s aha moment strikes: the other patients in the group smell just like the boy!

Here’s where the story enters the pages of a medical journal. With her newfound olfactory superpower, Joy Milne (“girl”) puts her nose to the grindstone and to a selection of unlaundered T-shirts. Researchers report that she accurately detected the scent of Parkinson disease in all T-shirts worn by those with the disease (vs those without). Long story short, Joy’s superpower led to the discovery of distinctive Parkinson markers in sebum and recently to a diagnostic test involving a simple swab of sebum on the skin. This test, in conjunction with the presence of Parkinson symptoms, can detect the disease with 95% accuracy.

Key takeaway

Joy and Les Milne’s story is a touching one, but what does it mean for you and your patients? It means that this noninvasive and faster (read: cheaper) swab test may soon be landing on your clinical doorstep. And that means that you could soon be making a much earlier diagnosis of Parkinson disease, leading your patients to earlier and more effective interventions. That is Joy Milne’s mission. It’s also the promise she made to “her Les” just before he ultimately succumbed to Parkinson disease.

Rapid-Fire COVID-19 Updates

COVID QUICK HITS 

Hot Take: Diet May Alleviate Hot Flashes

WOMEN’S HEALTH WISDOM

For most women, postmenopausal hot flashes and being called “ma’am” at the grocery checkout mark inevitable rites of passage in middle age. And while hormone therapy and antidepressants can offer some relief for the former, they also confer obvious risks. A recent small study presents an alternative intervention, one that is effective, nonpharmacologic, safe, and low cost—the perpetual Holy Grail of the clinical toolbox.

The intervention entails consuming a low-fat, plant-based, soybean-rich (one-half cup per day) diet. Postmenopausal women with daily hot flashes who adhered to this diet for 12 weeks experienced an 88% reduction in moderate-to-severe hot flashes (number needed to treat = 2) and noted an improvement in quality of life. Further, exactly half of those in the dietary intervention group reported no moderate-to-severe hot flashes at all.

Key takeaway 

Although researchers don’t fully know why, they conclude that a dietary equation of low fat (even avoiding the good fats, like nuts) plus no animal products plus a healthy dose of soybeans equals a significant and substantial reduction in hot flashes. In fact, they suggest making this diet first-line therapy. Based on these findings, you may want to advise postmenopausal patients to fill their grocery carts with soybeans and low-fat plant-based products. Maybe after Thanksgiving.

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

Morning Report is written by:

  • Alissa Scott, Author
  • Aylin Madore, MD, MEd, Editor
  • Eleni Scott, MD, Editor

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Please note that the summaries in Morning Report are intended to provide clinicians with a brief overview of an article, and while we do our best to select the most salient points, we ask that you please read the full article linked in each summary for clarification before making any practice-changing decisions.

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