COMMENTARY

Morning Report: Marijuana Benefits and Harms, Unconfirmed Asthma Diagnoses, and Hypertension in Older Adults Guidelines

Arefa Cassoobhoy, MD, MPH

Disclosures

January 27, 2017

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Hello. I'm Dr Arefa Cassoobhoy, a practicing internist and a medical editor for Medscape and WebMD. Welcome to our weekly brief on recent medical news and findings.

Marijuana: The Good and the Bad

With both recreational and medicinal uses of marijuana on the rise, the National Academies of Sciences, Engineering, and Medicine have released their first report since 1999 on the benefits and harms of cannabis use. Among the most significant harms, regular cannabis use is associated with mental health risks (psychoses, schizophrenia, social anxiety disorders, suicidal tendencies), respiratory disorders, low birth weight, and an increase in motor vehicle accidents.

On the other end of the spectrum, there were some benefits, including relief of chronic pain and chemotherapy-induced nausea and vomiting, Cannabis also seems to improve symptoms of multiple sclerosis spasticity. And marijuana may be effective for improving short-term sleep in patients with obstructive sleep apnea, fibromyalgia, chronic pain, and multiple sclerosis. Also, it may help increase appetite and decrease weight loss in HIV patients.

Still, researchers say that there's a gap in the evidence that doesn't allow for firm conclusions about short- or long-term use. They point out the need for a national cannabis research agenda, given that 22 million Americans over the age of 12 admit to regular use.

Confirm Previously Diagnosed Asthma

Next, you may want to consider testing patients who say they have been diagnosed with asthma.

Researchers in Canada have found that more than 33% of those with physician-diagnosed asthma showed no sign of actually having the condition upon re-evaluation. The study monitored symptoms, spirometry, home peak flow, and bronchial challenge tests.

Asthma can have a relapsing and remitting course, so diagnosis can be complicated, and it was unclear whether these patients had gone into remission or had been misdiagnosed. But among those retested and found not to have asthma, 35% were using medication that provided no benefit. More than 90% of participants whose asthma was ruled out safely stopped asthma medications.

The message is that while it's common to diagnose and treat asthma based on observation, testing for the condition is crucial to proper treatment.

New Guidelines: Hypertension in Older Adults

And finally, the American College of Physicians and the American Academy of Family Physicians have jointly issued guidelines on systolic blood pressure targets for people aged 60 years or older with hypertension. The guidelines are aimed at lowering blood pressure levels and reducing the risk for stroke, cardiac events, and death.

They offer three key recommendations:

  • If you have a patient who has a systolic blood pressure persistently above 150 mm Hg, start treatment immediately to achieve a target systolic below that number;

  • For those with a history of stroke or transient ischemic attack, consider a goal systolic blood pressure of less than 140 mm Hg.

  • For patients at high risk for a cardiovascular event, consider drug therapy to reach a systolic blood pressure less than 140 mm Hg.

The guidelines remind us that patients should be assessed for cardiac risk and periodically re-evaluated. An accurate blood pressure measurement must be ensured before beginning or changing treatment.

Discussions with patients should include the benefits and harms of specific blood pressure targets, especially in those with multiple chronic conditions, several medications, or frailty.

For Medscape and WebMD, I'm Dr Arefa Cassoobhoy.

Follow Dr Cassoobhoy on Twitter at @ArefaMD

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