It’s a shame that blood pressure recordings from the doctor’s office aren’t great predictors of future cardiovascular events due to white-coat hypertension, but it is what it is.

The long-recognized phenomenon is characterized by office-based BP readings that are higher and more labile than those taken during the course of normal everyday life.

Thankfully, scientists have shown that ambulatory blood pressure recording devices provide useful predictive information, particularly in those having severe hypertension, a cardiac history, multiple cardiovascular risk factors, pregnancy and elderly folks.

Now Gil Salles and co-investigators at University Hospital Clementino Fraga Filho in Rio de Janeiro, Brazil have shown that ambulatory blood pressure recordings can predict CV risk in another subset of patients, the ones with resistant hypertension.

Sales’ was a prospective study of 556 patients with resistant hypertension, defined as persistently elevated blood pressure despite treatment with 3 anti-hypertensive agents.

After median follow-up of 4.8 years, the scientists found that 109 patients (19.6%) either died or incurred a cardiovascular event.

After controlling for age, gender, prior cardiac events and other CV risk factors, Salas’ group confirmed that office-derived blood pressure recordings were not predictive of future events, but higher mean ambulatory BPs did predict these events.

Ambulatory systolic and diastolic blood pressure recordings were both effective predictors, and nighttime recordings were superior to those obtained during the day.

Britain’s National Institute for Health and Clinical Excellence (NICE) new treatment guidelines for attention-deficit hyperactivity disorder (ADHD) suggest that drugs should be used as first line therapy only for those who are severely impaired.

British physicians are strongly encouraged to implement the NICE recommendations, but they are not obligated to do so. Widespread adoption of the new guidelines would result in dramatic reductions in the use of Ritalin (Novartis) Concerta (Johnson & Johnson) and Strattera (Eli Lilly).

The NICE recommendations call for group-based parent education and training programs as the first line intervention for children with mild or moderate impairment due to ADHD. These behavioral/social interventions are also recommended, along with drug therapy, for severe cases.

NICE also stated that primary care physicians should neither diagnose ADHD nor start drug treatment on their own. These decisions should be left with psychiatrists, pediatricians or those having expertise in ADHD.

Approximately 3% of all school aged children are thought to have ADHD, but only a small percentage of them are severely impaired. In the US, more than 2.5 million children take drugs for ADHD.

A randomized controlled trial has revealed that for patients with osteoarthritis (OA) of the knee, arthroscopic surgery offers no benefit versus conservative therapy.

The arthroscopic intervention tested in this study is lavage and debridement. Conservative therapy included anti-inflammatory medications and physical therapy.

The investigators randomized 178 patients with moderate to severe OA. They assessed patient outcomes using two symptom-based questionnaires-the Western Ontario and McMaster Universities Osteoarthritis Index and the Short Form-36 Physical Component summary score. When investigators compared scores on these tests for the treatment and control groups at the end of two years, they found no significant difference. In particular, there was no difference in pain or activity level. Score comparisons at earlier time intervals also showed no difference.

The authors concluded that “the resources currently allocated towards arthroscopic surgery for osteoarthritis would be better directed elsewhere.”

Interestingly, Medicare stopped paying for the procedure in 2003 after an earlier study had come to the same conclusion, despite protests from many surgeons who felt the trial design was flawed. It is not clear how many arthroscopic surgeries for OA had been done between then and now (and presumably billed for using a reimbursable procedure code), but the number is probably in the hundreds of thousands per year.