Mild Hypertension: Garlic, Drugs, or Cocoa?

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BMJ 2012;345:e5450 

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Garlic, drugs, or cocoa for hypertension?

Cochrane Database Syst Rev2012;8:CD006742 [PubMed® abstract | Cochrane Library abstract PDF]

Cochrane Database Syst Rev2012;8: CD007653 [PubMed® abstract | Cochrane Library abstract PDF]

Cochrane Database Syst Rev2012;8:CD008893 [PubMed® abstract | Cochrane Library abstract PDF]

One review of four trials that comprised nearly 9000 participants looked at how well antihypertensive drugs prevent cardiovascular events and death in people with mild hypertension, defined as systolic blood pressure of 140-159 mm Hg or diastolic pressure 90-99 mm Hg (or both). All participants were free of cardiovascular disease at baseline.

No effects were seen over four to five years, compared with placebo, for overall mortality (relative risk 0.85, 95% CI 0.63 to 1.15), coronary heart disease (1.12, 0.80 to 1.57), stroke (0.51, 0.24 to 1.08), or total cardiovascular events (0.97, 0.72 to 1.32). One in 10 people stopped taking antihypertensives because of adverse effects, a fivefold increase over placebo. The review did not report effects of drugs on blood pressure, if any.

Another review found two small trials that compared garlic powder with placebo in people with mild hypertension. Garlic might help reduce blood pressure—possibly by about 10 mm Hg for systolic blood pressure and a little less for diastolic blood pressure. However, the confidence intervals were wide, and no data were available on which to assess the potency of garlic to prevent cardiovascular events.

Cocoa is rich in flavanols, which cause blood vessel dilatation and are thought to reduce blood pressure. Most of the 20 trials (about 850 participants) tested a daily dose of 500-750 mg of flavanols ingested through chocolate or cocoa products. Most participants were healthy and normotensive at baseline, and most trials lasted only about a month.

Small reductions in blood pressure were seen with cocoa, compared with placebo: −2.77 (−4.72 to −0.82) mm Hg for systolic pressure and −2.20 (−3.46 to −0.93) mm Hg for diastolic blood pressure. One in 20 people allocated cocoa had adverse effects, compared with one in 100 of those receiving placebo. Gastrointestinal effects and a dislike of the product's taste were the most common problems.

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Caffeine effective as an analgesic adjuvant

Caffeine effective as an analgesic adjuvant
September 17, 2012
PEARLS 362, July 2012, written by Brian R McAvoy

Clinical question: How effective is caffeine as an analgesic adjuvant for acute pain in adults?

Bottom line: Adding caffeine (at a dose equivalent to a mug of coffee, ie, about 100mg) to a standard dose of common analgesics, such as paracetamol or ibuprofen, increased the number of people with acute pain who experience a good level of pain relief (at least 50% of the maximum) by 5 to 10% (NNT* 15). The most common conditions studied were postoperative dental pain, postpartum pain, menstrual period pain and headache. One serious adverse event was reported with caffeine but was considered unrelated to any study medication. *NNT = number needed to treat to benefit 1 individual.

Caveat: Most comparisons individually demonstrated numerical superiority with caffeine but not statistical superiority.

Context: Caffeine is commonly used as a component in analgesics available from pharmacies without a prescription in the belief that it enhances analgesic efficacy.

Cochrane Systematic Review: Derry CJ et al. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Reviews, 2012, Issue 3. Article No. CD009281. DOI: 10.1002/14651858.CD009281.pub2. This review contains 19 studies involving 7238 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners

J Acad Nutr Diet. 2012 May;112(5):739-58. Epub 2012 Apr 25.
Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners.
Fitch C, Keim KS; Academy of Nutrition and Dietetics.

Source
West Virginia University, Morgantown, WV, USA.

Erratum in
J Acad Nutr Diet. 2012 Aug;112(8):1279.

Abstract
It is the position of the Academy of Nutrition and Dietetics that consumers can safely enjoy a range of nutritive sweeteners and nonnutritive sweeteners (NNS) when consumed within an eating plan that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary Reference Intakes, as well as individual health goals and personal preference. A preference for sweet taste is innate and sweeteners can increase the pleasure of eating. Nutritive sweeteners contain carbohydrate and provide energy. They occur naturally in foods or may be added in food processing or by consumers before consumption. Higher intake of added sugars is associated with higher energy intake and lower diet quality, which can increase the risk for obesity, prediabetes, type 2 diabetes, and cardiovascular disease. On average, adults in the United States consume 14.6% of energy from added sugars. Polyols (also referred to as sugar alcohols) add sweetness with less energy and may reduce risk for dental caries. Foods containing polyols and/or no added sugars can, within food labeling guidelines, be labeled as sugar-free. NNS are those that sweeten with minimal or no carbohydrate or energy. They are regulated by the Food and Drug Administration as food additives or generally recognized as safe. The Food and Drug Administration approval process includes determination of probable intake, cumulative effect from all uses, and toxicology studies in animals. Seven NNS are approved for use in the United States: acesulfame K, aspartame, luo han guo fruit extract, neotame, saccharin, stevia, and sucralose. They have different functional properties that may affect perceived taste or use in different food applications. All NNS approved for use in the United States are determined to be safe.

Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.