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Is It Safe To Reduce Hypertensive Medication Without Losing Blood Pressure Control?
~5.5 mins read

Some patients aged 80 or older can potentially cut back on their number of antihypertensive meds, under physician guidance, without an important loss of blood pressure (BP) control, conclude researchers based on their randomized multicenter trial.

Deprescription of 1 of at least 2 antihypertensive meds in such patients was found noninferior to usual care in keeping systolic BP below 150 mm Hg at 12 weeks, in the study that randomly assigned only patients whose primary care physicians considered appropriate for BP-med reduction.
Major trials that have shaped some contemporary hypertension guidelines, notably SPRINT, in general have not included such older patients with hypertension along with other chronic conditions, such as diabetes or a history of stroke. So, "it's difficult to know whether their data are relevant for frail, multimorbid patients. In fact, the guidelines say you should use some clinical judgment when applying the results of SPRINT to the kind of patients seen in clinical practice," James P. Sheppard, PhD, University of Oxford, United Kingdom, told theheart.org | Medscape Cardiology.
The current study, called Optimising Treatment for Mild Systolic Hypertension in the Elderly (OPTIMISE), entered "patients in whom the benefits of taking blood pressure-lowering treatments might start to be outweighed by the potential harms," Sheppard said.
The trial is meant to provide something of an otherwise-scant evidence base for how to deprescribe antihypertensive medications, said Sheppard, who is lead author on the report published May 25 in the Journal of the American Medical Association.
Of the trial's 282 patients randomly assigned to the drug-reduction group, 86.4% reached the primary endpoint goal of systolic BP less than 150 mm Hg, compared to 87.7% of the 287 patients on usual care, a difference which in adjusted analysis met the predetermined standard for noninferiority.
The intervention group reduced its number of antihypertensive agents by a mean of 0.6 per patient, which the authors describe as "a modest reduction." However, they note, drugs that were taken away could be reintroduced as judged necessary by the physicians, yet most of the group sustained their reductions until the end of the 12 weeks.
Had the primary endpoint instead specified a threshold of 130 mm Hg for BP control, which is more consistent with SPRINT and some guidelines in the United States, "the deprescribing strategy would have failed to be considered noninferior to usual care," as calculated by the OPTIMISE authors themselves, observes an accompanying editorial.
The 150 mm Hg threshold chosen by the trialists for the primary endpoint therefore "was somewhat of a low bar," write Eric D. Peterson, MD, MPH, Duke University, Durham, North Carolina, and Michael W. Rich, MD, Washington University School of Medicine, St. Louis, Missouri.
 

"Here in the UK it wouldn't be considered a low bar," Sheppard said in an interview. The National Institute for Health and Care Excellence guidelines in Britain "recommends that you treat people over the age of 18 regardless of whether they have any other conditions, and to 150 mm Hg systolic."
 
The study's general practitioners, he said, "did what we told them to do, and as a result, two thirds of the patients were able to reduce their medications. If we had a lower threshold for treatment, it's possible that more patients might have had medications reintroduced. I think you still could have potentially ended up with a noninferior result."
 
Participating physicians were instructed to enroll only "patients who, in their opinion, might potentially benefit from medication reduction due to 1 or more of the following existing characteristics: polypharmacy, comorbidity, nonadherence or dislike of medicines, or frailty," the report notes.
 
They chose which antihypertensives would be dropped for each patient and "were given a medication reduction algorithm to assist with this decision."  Physicians also followed a guide to monitoring for safety issues and were told to reintroduce medications if systolic BP exceeded 150 mm Hg or diastolic BP rose above 90 mm Hg for more than 1 week, or in the event of adverse events or signs of accelerated hypertension, the group writes.
 
In the deprescription group, the mean systolic BP rose 4.3 points from baseline to 12 weeks, from 129.4 to 133.7 mm Hg. For those given usual care, mean systolic BP went from 130.5 to 130.8 mm Hg. Adjusted, the mean change in systolic BP was 3.4 mm Hg greater (P = .005) in the intervention group.
 
The corresponding adjusted mean change in diastolic BP was a 2.2 mm Hg increase in the intervention group (= .001).
 
Although the difference seems minimal, write Peterson and Rich, "such differences in BP can potentially lead to long-term differences in outcomes at the population level."
 
Also, they pointed out, only about 10% of patients screened for enrollment actually entered the study, questioning the study's generalizability, and "patients in the trial had relatively well-controlled BP at baseline."
 
Sheppard said patients in the original screened population, taken from a national database, were directly invited to participate en masse by conventional mail, based on broad inclusion criteria. Far more than the number needed were invited, and nearly all of those excluded from the study had simply not responded to the invitation.
 
As for greater increases in systolic and diastolic pressures in the deprescribing group, the OPTIMISE authors acknowledge that "caution should be exercised when adopting this approach in routine clinical practice."
 
His own view, Sheppard said, "is that there are some patients who will definitely benefit from intensive blood pressure lowering like you saw in the SPRINT trial. And there's other patients who will benefit from deprescribing and having a slightly higher target. Those sorts of things very much need to be individualized at the patient level."
 
And ideally, he added, clinicians in practice should probably be even more selective in choosing patients for a deprescribing strategy, "and focus on people who are at the highest risk of adverse events."
 
Sheppard has disclosed no relevant financial relationships; disclosures for the other authors are in the report. Peterson discloses receiving personal fees from Cerner and Livongo and grants and personal fees from AstraZeneca, Janssen, and Amgen; Rick has disclosed no relevant financial relationships.
 
J Am Med Assoc. Published online May 25, 2020. AbstractEditorialM
Steve stilesM
ay 29, 2020
Medscape Medical News
 

 

 

 
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Scientist
How People In Ancient Times Treated Their Bacterial Infections? And Yes It Still Works.
~12.1 mins read
Shivangi Karn

Have you ever wondered how people in ancient times treated their bacterial infections? Yes, we are talking about natural antibiotics which were used much before the discovery of first man-made antibiotic (Penicillin) in 1928.

Antibiotics are widely used to kill bacteria and inhibit their growth. Natural antibiotics are the best as they come with minimal or no side effects. They also help in combating bacteria which have grown resistant to certain prescribed antibiotics. There is a large list of fruits, vegetables, essential oil and herbs which are known for their anti-microbial properties. We have listed down a few amazing mother nature's antibiotics that work just as effectively as prescribed antibiotics. Take a look.

1. Garlic

Garlic is a potent antibiotic for food pathogens. The food we eat contains pathogens which may decline consumer's health. This powerful natural antibiotic may help decrease the possibilities of food poisoning due to its antibacterial property against many types of bacteria, especially Staphylococcus aureus. [1]

2. Turmeric

Curcumin in turmeric is a bioactive compound that exhibits antimicrobial properties. In a vitro study, curcumin has demonstrated antibacterial quality against several gram-positive and gram-negative bacteria. This proves the antibioticnature of the compound. [2]

3. Honey

The antimicrobial property of honey has been mentioned since ancient times. Honey possesses healing property due to its antibacterial activity. Its high viscosity provides a protective barrier in preventing infections and the immunomodulatory effect for repairing wounds. [3]

4. Onion

Onion is a common and widely used herb in every kitchen. In a study based on oral health, onion extract has shown antibiotic effect against Streptococcus sobrinus and Streptococcus mutans, the primary bacteria causing gingivitis and periodontitis. [4]

5. Manuka Honey

Manuka honey is a type of honey that bees make after pollinating the manuka flower. The antimicrobial potency of honey is due to the rich phenolic content that makes it safe to use as a natural antibiotic. A study says that manuka honey inhibits the growth of bacteria and heals wounds. [5]

6. Carom seeds

Carom seeds, commonly known as ajwain is a well-known herb in India due to its remedial agents that help treat conditions such as flatulence, abdominal tumours, piles, asthma and many more. A study says that carvacrol and thymol in ajwain has an antibiotic property that not only kills normal but also multi-drug resistant bacteria. [6]

7. Ginger

A study shows that gingerols, a phenol phytochemical compound in fresh ginger, have antibacterial potency against all types of oral bacteria such as Porphyromonas gingivalis (causes gingivitis), Porphyromonas endodontalis (causes gum disease) and Prevotella intermedia (causes periodontitis). [7]

8. Clove

Clove is widely used in seasoning many dishes. It is effective against various gram-positive and gram-negative bacteria due to the presence of eugenol, lipids and oleic acid. Clove is basically used for its essential oil. [8]

9. Cinnamon

Cinnamon is widely used in the preparation of chocolates, soups, liquors, beverages and pickles. Every part of the plant is used to prepare essential oil which is useful in treating multiple ailments. The active compound such as cinnamaldehyde and eugenol in cinnamon have antimicrobial property against bacteria causing pneumonia, urinary tract infection, fever and skin infection. [9] Cinnamon oil should be taken in safe amount considering its toxicity as a main problem. It is better to consult a medical expert about its usage.

10. Basil

Known by the name 'tulsi', basil is the mostly found herb in every Indian garden. In a study conducted among nine essential oils, basil oil had shown the strongest antimicrobial property against different bacteria including S. Enteritidis, a bacterium that severely affect humans by causing gastrointestinal problems. [10]

11. Lavender

A study highlights the antibacterial property of lavender. It says that lavender essential oil has a very good inhibitory growth activity against E. coli (Gram-negative bacteria) and S. aureus (Gram-positive bacteria) strains. [11]

12. Blueberries

Blueberries are rich in phenols, flavonoids and polyphenols. The compound possesses antimicrobial property against bacteria such as E.coli, L. monocytogenes and salmonella. Also, it helps in maintaining the health of good bacteria (lactobacillus) found in our digestive system. [12]

13. Oregano

The essential oil obtained from oregano is famous for its antimicrobial activity. In a study, the oil was found to be effective against Escherichia coli (cause diarrhoea) and Pseudomonas aeruginosa (causes pneumonia and UTI). The outcome of the study shows that oregano oil can be used as an alternative for antibiotics against bacterial infections and antibiotic-resistant strains. [13]

14. Neem

Neem is a recognised medicinal plant known very much for its antibacterial property. Vibrio vulnificus is a gram-negative pathogenic bacterium transmitted to humans mainly through seafood. When people consume undercooked or raw seafood, they get inside the human body and cause symptoms such as fever, sepsis, vomiting and necrotising fasciitis. Neem nanoemulsion (NE) prepared from neem oil, water and Tween 20 (a surfactant) disrupt the integrity of the bacteria by acting as an antibiotic. [14]
Note: Neem NE is nontoxic at lower concentration. Avoid its overconsumption.

15. Fennel Seeds

Fennel is a natural antibiotic used to treat multiple bacterial conditions such as gastrointestinal disorder and respiratory problems. In a study, fennel seeds were found to be potent against S. aureus bacteria that cause skin disorders like infection, pimples, boils, cellulitis and scalded skin syndrome. [15]

16. Coconut Oil

A study shows that in comparison to chlorhexidine (an antiseptic and disinfectant), coconut oil is as effective as the prior in reducing Streptococcus mutans bacteria (teeth bacteria) due to its antimicrobial property. [16] Another study states that virgin coconut oil inhibits the growth of Clostridium difficile, an antibiotic-resistance bacterium responsible for diarrhoea. [17]

17. Chili Peppers

Chili peppers contain an active compound called capsaicin that holds a great antibiotic activity. It's been used since ancient times to treat multiple disorders. A study shows the antibacterial activity of this vital compound against Streptococcus pyogenes which is a major human pathogen. [18]

18. Tea Tree Oil

Tea tree essential oil has been used to treat multiple ailments for almost 100 years. The oil is used in many topical formulations to treat skin and mucous membrane infections. Terpene compound in this oil is responsible for its antibacterial activity. [19]

19. Green Tea

Green tea is packed with flavonols (catechins). This active compound is a health-promoting component with great antibacterial effect. In a study conducted between green, black and herbal teas, green tea has shown effectiveness against three types of gram-positive bacteria named M. luteus, Staphylococcus and B. cereus along with S. aureus, while the other two were not able to inhibit S.aureus. [20]

20. Lemongrass

This native herb from Sri Lanka and South India has gained popularity around the world due to its amazing antimicrobial property. A study mentions the effect of lemongrass oil against seven species of gram-negative bacteria, three of which are zoonotic from pet turtle. The oil extracted from lemongrass is used for its aroma, bactericidal property, flavour and medicinal properties. [21]
9 Amazing Health Benefits Of Citronella Oil (Lemongrass)

21. Bearberry

Bearberry or uva-ursi is a small cherry-like red-pink fruit with great medicinal value. It is a safe and effective alternative treatment method for urinary tract infection. The consumption of uva-ursi by women helps to reduce prescribed antibiotic use. [22]

22. Myrrh

Also known as loban, myrrh is an aromatic plant used for a thousand years for its incense and medicinal property. The oil extracted from this traditional plant has the potential of an antibiotic to kill persister cells or nongrowing bacteria (highly resistant to antibiotic) and cause no resistance development. [23]

23. Thyme Oil

Thyme is a relative to oregano commonly used for ornamental, culinary and medicinal purpose. A study says that thyme oil has antibacterial activity against multiple strains of bacteria responsible for oral cavity, respiratory problems, skin infections and abdominal disorders. [24]

24. Rosemary

Rosemary is a fragrant evergreen herb with spiny leaves and white/purple/pink/blue flowers. The phenolic compounds such as carnosic acid and rosmarinic acid in rosemary possess antibacterial property against all strains of gram-negative bacteria, especially Esherichial coli responsible for diarrhoea and fever in humans. [25]

25. Echinacea

Echinacea, also known as coneflower is a flowering plant that belongs to the daisy family. They are mainly recognised by their pink or purple petals. The herb is popular for its antibiotic effect against fever, cough and flu. It is also used in the treatment of multiple bacterial infections. [26]

Risks Of Taking Natural Antibiotics

Natural antibiotics are good but it does not mean one should take them all the time. Market-based antibiotic supplements which are labelled as 'natural and safe' can sometimes be harmful. Therefore, it is better to consult a medical expert before starting on these supplements.
Some of the common side effects related to natural antibiotics are allergic reactions and gastric distress. They sometimes interfere with gut microbiota and cause problems. Another problem is natural antibiotics may sometimes interfere with the medications which you are taking for your existing medical condition.
Garlic is considered a major antibiotic but sometimes it may prolong bleeding and cause drug interactions. Neem oil in a large proportion may harm kidneys while ginger may slow down blood clotting in some people.
Too much of anything is bad. Therefore, the best way to get the benefits of the aforementioned natural antibiotics is to take them as recommended.

Common FAQs

1. What is the most powerful natural antibiotic?
Basil, commonly known as tulsi is considered the most powerful antibiotic as its antimicrobial effect is stronger than essential oils, which are themselves considered potent against several bacterial infections.
2. How can I fight infection naturally?
Natural antibiotics are preferred best for fighting infection naturally. They include garlic, honey, turmeric, muneka honey, ginger and essential oils. The active compounds in them help treat many bacterial infections.
3. Can you get rid of a bacterial infection without antibiotics?
Effective natural antibiotics such as turmeric, honey, ginger and garlic lower the chance of different types of bacterial infections. Therefore, people who want to get rid of such infections without prescribed antibiotics should start including these in their diet.
4. What can I take instead of antibiotics?
Powerful natural antibiotics such as garlic, turmeric, honey and ginger come with minimal or no side effects and are used daily in foods. They also help in killing antibiotic-resistant bacteria. If you include such natural antibiotics daily in your diet, you can improve your chances to fight an infection.
5. Is apple cider vinegar an antibiotic?
Yes, apple cider vinegar (ACV) is considered a powerful antibiotics. The organic acids, polyphenols, vitamins and flavonoids in ACV help against multiple strains of bacteria such as E. coli, S. aureus and C. albicans.

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